Biopsychosocial Model Vs Biomedical Model

Healthcare (Basel). 2017 Dec; v(iv): 88.

The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Affliction

Albert Farre

¹Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK

Tim Rapley

²Section of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, Uk; ku.ca.airbmuhtron@yelpar.mit

Received 2017 Jul 31; Accepted 2017 Nov 14.

Abstruse

The importance of how affliction and illness are conceptualised lies in the fact that such definition is paramount to sympathize the boundaries and telescopic of responsibility associated with medical piece of work. In this paper, nosotros aim to provide an overview of the interplay of these understandings in shaping the nature of medical work, philosophically, and in do. We first discuss the emergence of the biopsychosocial model as an endeavour to both claiming and broaden the traditional biomedical model. And so, we outline the main criticisms associated with the biopsychosocial model and note a range of contributions addressing the shortcomings of the model as initially formulated. Despite recurrent criticisms and uneven uptake, the biopsychosocial model has gone on to influence core aspects of medical practice, education, and research beyond many areas of medicine. One of these areas is adolescent medicine, which provides a peculiarly good exemplar to examine the contemporary challenges associated with the practical awarding of the biopsychosocial model. We conclude that a more optimal utilize of existing bodies of bear witness, bringing together prove-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific weather condition/populations, can help to bridge the gap between philosophy and exercise.

Keywords: medical philosophy, psychosocial aspects, wellness care delivery, attitude of health personnel, doc-patient relations, medical folklore

1. Introduction

Medical piece of work tin be understood equally a gear up of practices (such every bit listening, request questions, diagnosing, or recommending treatments) undertaken past doctors to help those who seek medical attending. At the core of such medical work is the definition of 'disease' and 'disease', two terms rooted in different understandings of people's 'sick health'.

Whilst the term 'disease' would typically have a strictly physiologically based definition, the term 'illness' would typically be defined in terms of the homo experience of 'sick wellness', encompassing both an objective and a subjective reality in its definition. As Idler [i] describes it:

'it is possible for an individual to have a disease, still be unaware of information technology and human activity appropriately; it is too possible for people to feel and/or human action sick without showing evidence of any objectively verifiable disease. In the former case there is no illness, though there may exist disease. In the latter instance in that location is certainly affliction'.

(p. 723)

Thus, the importance of how the object of medical work is conceptualised (i.due east., in terms of disease or illness) lies in the fact that such a definition is paramount to sympathise the boundaries and telescopic of responsibility associated with such work [2,iii,4].

Hence, a 'narrow definition' of the object of medical work in terms of disease—as strictly concerned with organic malfunction—will translate into a medicine exclusively concerned with the concrete aspects of illness. In this mode, affliction is a biomedical concept. On the other hand, a 'broad definition' of the object of medical piece of work in terms of illness—as concerned with the life world of the patient—will translate into a medicine that directs clinical attention to all domains of man life, comfortable in the idea that the boundaries betwixt health and illness, between well(ness) and sick(ness), are diffused past cultural, social, and psychological considerations [three].

The aim of this paper is to provide an overview of the interplay of these conceptual approaches in shaping the nature of medical work, philosophically and in practice. We showtime talk over the ascension of the biopsychosocial model in medicine as an attempt to both claiming and broaden the traditional biomedical model. We then synthesise the key controversies and criticisms associated with it, and illustrate the current relevance and engagement with the model before outlining some terminal remarks in light of the subject thing of this special result, boyish wellness and medicine.

two. Questioning the Biomedical Approach: The Rise of the Biopsychosocial Model in Medicine

Across a fix of papers published between 1960 and 1980 [2,3,v,six,7], George Engel articulated an influential questioning of the historically ascendant model of medicine, the biomedical model. He outlined the limitations of such arroyo and called for the demand of a new medical model—which Engel himself characterised as the 'biopsychosocial model' [three,8].

Following Engel'south critique, the traditional biomedical approach, which 'assumes affliction to be fully deemed for by deviations from the norm of measurable biological (somatic) variables' [3], leaves no room within its framework for the social, psychological, and behavioural dimensions of illness. Engel argued that this led to a fundamental paradox that 'some people with positive laboratory findings are told that they are in need of treatment when in fact they are feeling quite well, while others feeling sick are assured that they are well' [3] and went on to plant that:

'the existing biomedical model does not suffice. To provide a basis for understanding the determinants of affliction and arriving at rational treatments and patterns of wellness care, a medical model must also have into business relationship the patient, the social context in which he [sic] lives, and the complementary system devised by order to bargain with the disruptive effects of affliction, that is, the doctor role and the health intendance system. This requires a biopsychosocial model'.

(p. 132)

In other words, Engel proposed to broaden the biomedical approach to include the psychosocial without sacrificing the advantages of the biomedical approach [7] so that 'patients would continue to exist cared for from a disease standpoint only, additionally, psychological and social information would be given equal standing in the care procedure' [9].

In doing so, a health professional should be able to evaluate all the factors contributing to illness, whilst recognising some factors as more than important than others, and some fifty-fifty as a necessary status for (as opposed to the cause of) illness, rather than giving primacy to biological factors alone [2]. With that in mind, Engel noted that basic professional person knowledge and skills should bridge the social, psychological, and biological given that medical decisions and actions on the patient'due south behalf involve all three domains [3].

Engel's proposal was theoretically informed by the full general organisation theory [10,eleven], which is based on the idea that all entities (systems), from the smallest discernible system in physics to the largest system in the cosmos, are structurally and functionally interconnected from level to level with continuous feedback loops [9]. Engel argued that such a conceptual arroyo was well-suited for his proposed biopsychosocial concept and had the potential to mitigate the holism–reductionist dichotomy likewise as improve communication across scientific disciplines [3].

By applying such reasoning to medicine, Engel defined the biopsychosocial model as encompassing information from the levels beneath and in a higher place the homo every bit experienced by each person—that is, the health professional seeks to integrate data from the human/psychological level with data from the biological level (below) and information from the social level (above) to construct the biopsychosocial description of each patient (Figure 1).

An external file that holds a picture, illustration, etc. Object name is healthcare-05-00088-g001.jpg

Schematic representation of the hierarchy and continuum of natural systems every bit applicable to Engel's definition of the biopsychosocial model—adapted from 'The clinical application of the biopsychosocial model' [7].

According to this framework, it must be best-selling that each level in the bureaucracy operates according to a unique system (e.g., tissues and organs at biological level; perception and experience at psychological level; attribution of meaning at social level); withal, it is the integration of these systems that is disquisitional in terms of agreement the patient's biopsychosocial story. Thus, patient-health professional communication becomes a fundamental stepping rock to integrating the diverse levels and understanding illness and help-seeking behaviour [9,12].

Given that Engel's proposal was theoretically informed he too argued that, with subsequent empirical support, not just the model had the potential to interpret into more than humanistic intendance, simply besides to make medicine more than scientific [9]. All the same, whilst information technology is widely accustomed that the biopsychosocial model has the potential to pb to more than humanistic and patient-centred intendance, there have been a range of recurring criticisms and controversies associated to its rise, including its amenability to scientific inquiry, as we go on to explore in the following section.

3. The Biopsychosocial Model in Medicine: Key Controversies and Criticisms

Post-obit Smith et al. [9], the major criticisms of the biopsychosocial model fall into 3 broad, overlapping categories:

The model was likewise vaguely defined and therefore not testable. A number of authors accept suggested that a core limitation of the model, as originally formulated by Engel, was the conceptual underdevelopment [13,14] and lack of operationalisation [xv,xvi], which involved the compromise that the model was not set to be empirically tested. Some authors such as McLaren [17] even suggested that the model cannot exist referred to as a 'model', given that it does not conform to the notion of 'model' understood every bit a formal working, representation of an idea or theory that can be empirically tested and holds some predictive and/or explanatory power.
The model's telescopic was too generic and cannot exist efficiently put in practice. Other authors have emphasised that the conception of the biopsychosocial model is so generic in its telescopic that provides little guidance to health professionals [16] and raises the problem of how to selectively employ the model without any accompanying criteria to locate and specify relevant patient information [18,nineteen]. This can upshot in an overwhelming scope of loosely related biopsychosocial data that renders the model too fourth dimension-consuming and inefficient to be applicable for individual patients in do [20], leaving some to wonder 'whether in that location can be a indicate of diminishing returns in fighting reductionism with inclusionism' [21].
The model did not include a method to identify relevant biopsychosocial data. Some authors noted that the model focuses on the need to elicit biopsychosocial information without providing whatever methodological guidance to help this process [17]. Within this, critics take also pointed out that the model does not indicate what level of assay (biological, psychological, or social) to prioritise or when [nineteen], and, since information technology is oft not known which factor might be the ultimate responsible for a given condition, all levels of analysis routinely co-exist and clinicians are left to choose the level that seems to work best [22], without a shared rationale every bit to why a given clinician heads in one direction or the other [23].

Alongside these, diverse authors, including most critics, have addressed what they saw as shortcomings of the biopsychosocial model as initially formulated and a number of 'solutions' have been proposed over the years.

For example, Schwartz & Wiggins [18] proposed a phenomenological model, addressing the 'weaknesses' of the biopsychosocial model past focusing on the fundamental 'necessity of understanding' (that is, the doctor's need to 'understand patients') which, they argued, emphasised 'the relevance of both the man and natural sciences to medical scientific discipline'.

Later on on, Foss & Rothenberg [15] suggested that Engel's biopsychosocial model (and its limitations/critiques) had to be read every bit a transition between the various compromises associated with the biomedical model and a more comprehensive model, which they went on to codify and chosen the 'infomedical model' [xv].

However, the thought of a biopsychosocial approach to medical work seemed to accept struck a peculiarly resonant chord, and neither the criticisms nor the calls for new, improved models overshadowed the appeal of Engel's proposal. Thus, regardless of how 'flawed' it was as a model, the idea of a biopsychosocial approach that would meliorate but non alienate the traditional biomedical approach, resonated with various sectors of the medical profession that wanted to meet medical practise informed by a more encompassing understanding of wellness and illness, more in tune with the actual experiences of those who seek care [24]. Despite the criticisms, the biopsychosocial model went on to influence core aspects of medical practise, education, and research.

4. The Relevance of the Biopsychosocial Model in Current Practice, Research, and Policy

Despite the recurrent criticisms since the biopsychosocial model establish its way into the mainstream debates in the medical profession and an arguably historically uneven uptake of psychosocial understandings of health and illness in practice and research [25], the broad principles of the biopsychosocial model have increasingly been echoed in guidance and policy documents. Over the concluding four decades, the very concept of wellness has transformed from the traditional biomedical definition as 'absence of disease' to a more than encompassing understanding rooted in a more psychosocial understanding of wellness and illness.

Likewise, the core problems and limitations associated with Engel'southward initial formulation of the model have increasingly been addressed in the context of 'solutions' aimed at appending or complementing, rather than replacing, the biopsychosocial model [26]. For example, Herman [20] suggested that the biopsychosocial model raised the need for a transitional, more pragmatic model (the dissever model) which 'relegates the psychosocial to the position of being simply another tool in the doctor's pocketbook' simply makes the task of thinking 'biopsychosocially' attainable for health professionals in practice. Kontos [21] has argued that the complexity of contemporary medicine is non suited for a unmarried model. Other authors have formulated a range of contributions in terms of 'farther developments' [24], including teachable 'habits of listen' with the potential to enable a realistic connection between the biopsychosocial vision and the clinical reality [27]; 'addendums' [19] and 'means to realise' [28] the biopsychosocial model; 'strategies' for bridging and ameliorate integrating its three levels of analysis in practice and inquiry [29,xxx]; more recently, Smith et al. [9] have proposed a more encompassing 'solution' past addressing the following question: Exactly how do health professionals efficiently identify essential biopsychosocial data when caring for an individual patient at a given point in time?

This proposal was in essence a methodological response to the three cadre criticisms noted above, arguing that the availability of 'a repeatable method that consistently identifies only the relevant biological, psychological, and social data needed to define the BPS [biopsychosocial] model at each visit' would make the model scientific and enable farther improvements in the clinical, educational, and research arenas. In Smith et al.'s [9] view, this method was to focus on the near important source of biopsychosocial data in each clinical meet, i.e., the medical interview. Thus they suggested that the biopsychical model could be operationalised by integrating ii evidence-based, behaviourally defined patient-centred interviewing methods: the 'integrated patient-centred and dr.-centred interview model' and the 'four habits interviewing model'. These are known to 'produce highly relevant illness, personal/social, and emotional information' rather than all biopsychosocial data [9] and have been associated with constructive and efficient learning [31,32] and positive health outcomes [33,34] via randomised controlled trials. Past providing the biopsychosocial model with a method transformed the general model initially formulated by Engel into a specific model for each clinical come across, translating the model into an show-based, consistently defined, intervention with the potential to accost its core shortcomings.

Similarly, debates and changes in the medical education arena besides reflect this trend [35] with calls for reforms in medical education to transform primarily biomedical-focused curricula into more encompassing programmes that also incorporate learning from behavioural and social sciences, enabling medical educators to accordingly respond to the demand for increased psychosocial competence of future medical professionals [36,37,38].

Accounting for a like tendency, official bodies such every bit the National Institute for Health and Intendance Excellence in the United Kingdom or the Establish of Medicine in the United States have acknowledged the need to accost the psychosocial dimension of patients' wellness concerns, through the implementation of more and improved patient-centred practices, as a way to amend the quality of health care [39,xl,41]. Although, every bit Wade and Halligan noted [42], the biopsychosocial model has had piddling influence on the larger scale organisation, funding, and commissioning of health intendance services.

Thus, there is now a greater need to employ the biopsychological model to healthcare direction to reply to its growing uptake in practice and research [42], where at that place have been increasing reports of the awarding and utilise of the biopsychosocial model—with recently published examples ranging from cardiology [43] to oncology [44], full general paediatrics and internal medicine [45], orthopaedics [46], and obstetrics and gynaecology [47], among many other areas where attempts have been fabricated to implement and evaluate the biopsychosocial model [48,49].

5. A Question of Method and Discipline: The Future of the Biopsychosocial Model through the Lens of Adolescence Medicine

Whilst further piece of work is however needed to address some limitations and emerging problems associated with the practical awarding of the biopsychosocial model both in clinical do and research, sustained philosophical and political traction is translating in increasing examples from across all areas of medicine. These are already paving the way to farther develop the biopsychosocial model in low-cal of concerns previously raised.

One of these areas is adolescent wellness and medicine [45,fifty,51]. The provision of health services for young people provides a especially expert exemplar to examine the contemporary challenges associated with the practical implementation of the biopsychosocial model. Firstly, adolescent wellness care has historically been geared towards a more than biopsychosocial understanding of wellness and affliction: Its cadre principles are 'based on a biopsychosocial approach to clinical interactions' [52], aiming to provide a 'complete and thorough physical and psychosocial evaluation and treatment in an temper of trust and confidentiality' [53] to better see the circuitous and inherently all-encompassing nature of developmental needs of adolescents and young adults [54]. Secondly, considering the historic period range of young people—that is, ten–24 years [55]—locate adolescent services correct at the intersection of paediatric and adult care, this provides a unique opportunity to explore such challenges in the context of the wider arrangement of the health care organisation, particularly for those with chronic conditions who will need to movement from child- to adult-focused care [41].

However, bridging the gap between philosophy and practice to better integrate the biomedical and psychosocial facets of wellness and disease is still challenging, fifty-fifty in areas such as boyish medicine, where the model advocated for past adolescent health specialists is often far from the experiences of young people using wellness services [56] and where different approaches to the integration between the biomedical and psychosocial facets of healthcare coexist among clinicians [57].

All the same, a more than optimal use of existing bodies of evidence can help to bridge this gap between philosophy and exercise. In item, changes in actual clinical practise could be facilitated by bringing together evidence-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, thus helping to further tailor and assist the practical implementation of the model and proposed method through specialty/status/population related guidance for clinicians. For example, in terms of boyish medicine:

On the ane hand, the pivotal advance introduced by Smith et al. [9] linking the biopsychosocial model to an evidence-based patient-centered interview method, addresses the iii major concerns with the biopsychosocial model and enables the operationalisation of the biopsychosocial model for its apply in each consultation.
On the other hand, at that place is a growing only well-established body of evidence on the specific health and psychosocial needs of adolescents that should exist addressed in each consultation. These are detailed in the reviewed Dwelling house, Educational activity/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety (HEEADSSS) tool [58,59,sixty], a psychosocial interview tool which has been described as the aureate standard in obtaining a developmentally appropriate psychosocial history from young people [61].

Building on the methodological advances by Smith et al. [nine], the practical implementation of the biopsychosocial model could exist facilitated by further tailoring the description of the proposed patient-centered interview method, drawing on evidence-based recommendations and guidance on the psychosocial needs for a given specialty/condition/population.

In addition, it is equally important to consider that policy frameworks and clinical guidelines besides have the potential to enable farther advances in the practical implementation of the biopsychosocial model in a number of means. For case, by edifice psychosocial aspects of health and illness into clinical governance and the judgment of the quality of care, or by redefining and devising new roles to further ingrain multi-disciplinary and trans-disciplinary work in routine clinical practice. Equally, establishing an applied health research agenda, responsive to the multidisciplinary and complex nature of the psychosocial understandings of health and disease, tin can inform the farther development (both conceptual and methodological) and further refining and reshaping of an integrated model that successfully integrates the biomedical and the psychosocial understandings of wellness and illness in medical work.

Acknowledgments

Albert Farre is funded by the National Establish for Health Research (NIHR) Collaboration for Leadership in Applied Health Enquiry and Care (CLAHRC) W Midlands. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Section of Health.

Conflicts of Interest

The authors declare no conflict of involvement.

References

1. Idler East.L. Definitions of health and affliction and medical sociology. Soc. Sci. Med. Part A Med. Psychol. Med. Sociol. 1979;13:723–731. doi: x.1016/0271-7123(79)90118-four. [PubMed] [CrossRef] [Google Scholar]

2. Engel G.L. A unified concept of health and disease. Perspect. Biol. Med. 1960;three:459–485. doi: x.1353/pbm.1960.0020. [PubMed] [CrossRef] [Google Scholar]

iii. Engel G.50. The demand for a new medical model: A challenge for biomedicine. Science. 1977;196:129–136. doi: 10.1126/scientific discipline.847460. [PubMed] [CrossRef] [Google Scholar]

iv. Jennings D. The confusion betwixt disease and illness in clinical medicine. CMAJ. 1986;135:865–870. [PMC costless commodity] [PubMed] [Google Scholar]

5. Engel G.L. The care of the patient: Art or science? Johns Hopkins Med. J. 1977;140:222. [PubMed] [Google Scholar]

6. Engel G.L. The biopsychosocial model and the didactics of health professionals. Ann. N. Y. Acad. Sci. 1978;310:169–181. doi: 10.1111/j.1749-6632.1978.tb22070.x. [PubMed] [CrossRef] [Google Scholar]

vii. Engel G.Fifty. The clinical awarding of the biopsychosocial model. Am. J. Psychiatry. 1980;137:535–544. [PubMed] [Google Scholar]

eight. Engel M.L. Correspondence. Psychosom. Med. 1961;23:427–429. doi: ten.1097/00006842-196109000-00010. [CrossRef] [Google Scholar]

ix. Smith R.C., Fortin A.H., Dwamena F., Frankel R.M. An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Educ. Couns. 2013;91:265–270. doi: 10.1016/j.pec.2012.12.010. [PubMed] [CrossRef] [Google Scholar]

10. Von Bertalanffy L. An Outline of General Arrangement Theory. Br. J. Philos. Sci. 1950;ane:134–165. doi: 10.1093/bjps/I.2.134. [CrossRef] [Google Scholar]

11. Von Bertalanffy L. Full general System Theory: Foundations, Development, Applications. Revised ed. George Braziller; New York, NY, The states: 2015. [Google Scholar]

12. Engel G.50. From Biomedical to Biopsychosocial: Beingness Scientific in the Human Domain. Psychosomatics. 1997;38:521–528. doi: 10.1016/S0033-3182(97)71396-3. [PubMed] [CrossRef] [Google Scholar]

13. Malmgren H. The theoretical footing of the biopsychosocial model. In: White P., editor. Biopsychosocial Medicine: An Integrated Arroyo to Understanding Illness. Oxford University Press; Oxford, U.k.: 2005. pp. 21–35. [Google Scholar]

14. Van Oudenhove Fifty., Cuypers South. The relevance of the philosophical "mind-trunk problem" for the status of psychosomatic medicine: A conceptual analysis of the biopsychosocial model. Med. Wellness Care Philos. Dordr. 2014;17:201–213. doi: 10.1007/s11019-013-9521-i. [PubMed] [CrossRef] [Google Scholar]

15. Foss L., Rothenberg K. The Second Medical Revolution: From Biomedicine to Infomedicine. 1st ed. Shambhala; Boston, MA, The states: 1987. [Google Scholar]

sixteen. Ghaemi S.N. The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry. Johns Hopkins University Press; Baltimore, MD, U.s.a.: 2010. [Google Scholar]

17. McLaren N. A Critical Review of the Biopsychosocial Model. Aust. Northward. Z. J. Psychiatry. 1998;32:86–92. doi: ten.3109/00048679809062712. [PubMed] [CrossRef] [Google Scholar]

xviii. Schwartz M.A., Wiggins O. Science, humanism, and the nature of medical practice: A phenomenological view. Perspect. Biol. Med. 1985;28:331–361. doi: 10.1353/pbm.1985.0008. [PubMed] [CrossRef] [Google Scholar]

nineteen. Freudenreich O., Kontos North., Querques J. The Muddles of Medicine: A Practical, Clinical Addendum to the Biopsychosocial Model. Psychosomatics. 2010;51:365–369. doi: 10.1016/S0033-3182(10)70717-nine. [PubMed] [CrossRef] [Google Scholar]

20. Herman J. The Need for a Transitional Model: A Challenge for Biopsychosocial Medicine? Fam. Syst. Health Spec. Result Curr. State Biopsychosoc. Approach. 2005;23:372–376. doi: 10.1037/1091-7527.23.four.372. [CrossRef] [Google Scholar]

21. Kontos Northward. Perspective: Biomedicine—Menace or harbinger homo? Reexamining the biopsychosocial argument. Acad. Med. 2011;86:509–515. doi: x.1097/ACM.0b013e31820e0d16. [PubMed] [CrossRef] [Google Scholar]

22. Searight H.R. The Biopsychosocial Model: "Reports of My Death Have Been Profoundly Exaggerated." Cult. Med. Psychiatry. 2016;40:289–298. doi: 10.1007/s11013-015-9471-6. [PubMed] [CrossRef] [Google Scholar]

23. Ghaemi S.North. The rise and fall of the biopsychosocial model. Br. J. Psychiatry. 2009;195:3–4. doi: x.1192/bjp.bp.109.063859. [PubMed] [CrossRef] [Google Scholar]

24. Borrell-Carrió F., Suchman A.50., Epstein R.G. The Biopsychosocial Model 25 Years Afterwards: Principles, Practice, and Scientific Research. Ann. Fam. Med. 2004;2:576–582. doi: 10.1370/afm.245. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

25. Alonso Y. The biopsychosocial model in medical enquiry: The evolution of the health concept over the terminal 2 decades. Patient Educ. Couns. 2004;53:239–244. doi: x.1016/S0738-3991(03)00146-0. [PubMed] [CrossRef] [Google Scholar]

26. Sadler J.Z., Hulgus Y.F. Knowing, valuing, interim: Clues to revising the biopsychosocial model. Compr. Psychiatry. 1990;31:185–195. doi: 10.1016/0010-440X(90)90001-nine. [PubMed] [CrossRef] [Google Scholar]

27. Epstein R.Grand., Borell-Carrio F. The biopsychosocial model: Exploring vi impossible things. Fam. Syst. Wellness. 2005;23:426. doi: ten.1037/1091-7527.23.4.426. [CrossRef] [Google Scholar]

28. Epstein R.M. Realizing Engel's Biopsychosocial Vision: Resilience, Compassion, and Quality of Intendance. Int. J. Psychiatry Med. 2014;47:275–287. doi: ten.2190/PM.47.4.b. [PubMed] [CrossRef] [Google Scholar]

29. Suls J., Krantz D.S., Williams 1000.C. 3 Strategies for Bridging Dissimilar Levels of Analysis and Embracing the Biopsychosocial Model. [Editorial] Health Psychol. 2013;32:597–601. doi: x.1037/a0031197. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

xxx. Hatala A.R. The Condition of the "Biopsychosocial" Model in Health Psychology: Towards an Integrated Approach and a Critique of Cultural Conceptions. Open up J. Med. Psychol. 2012;1:51–62. doi: 10.4236/ojmp.2012.14009. [CrossRef] [Google Scholar]

31. Smith R.C., Lyles J.Southward., Mettler J., Stoffelmayr B.Due east., Van Egeren Fifty.F., Marshall A.A., Gardiner J.C., Maduschke K.M., Stanley J.M., Osborn G.Thou., et al. The Effectiveness of Intensive Preparation for Residents in Interviewing: A Randomized, Controlled Study. Ann. Intern. Med. 1998;128:118–126. doi: 10.7326/0003-4819-128-2-199801150-00008. [PubMed] [CrossRef] [Google Scholar]

32. Jensen B.F., Gulbrandsen P., Dahl F.A., Krupat East., Frankel R.M., Finset A. Effectiveness of a brusk class in clinical communication skills for hospital doctors: Results of a crossover randomized controlled trial (ISRCTN22153332) Patient Educ. Couns. 2011;84:163–169. doi: 10.1016/j.pec.2010.08.028. [PubMed] [CrossRef] [Google Scholar]

33. Smith R.C., Lyles J.Southward., Gardiner J.C., Sirbu C., Hodges A., Collins C., Dwamena F.C., Lein C., Given C.West., Given B., et al. Chief Care Clinicians Treat Patients with Medically Unexplained Symptoms: A Randomized Controlled Trial. J. Gen. Intern. Med. 2006;21:671–677. doi: 10.1111/j.1525-1497.2006.00460.10. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

34. Smith R.C., Gardiner J.C., Luo Z., Schooley S., Lamerato Fifty., Rost One thousand. Primary care physicians treat somatization. J. Gen. Intern. Med. 2009;24:829–832. doi: 10.1007/s11606-009-0992-y. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

35. Institute of Medicine . Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical Schoolhouse Curricula. National Academies Press; Washington, DC, U.s.: 2004. [Google Scholar]

36. Frenk J., Chen Fifty., Bhutta Z.A., Cohen J., Crisp Due north., Evans T., Fineberg H., Garcia P., Ke Y., Kelley P., et al. Health professionals for a new century: Transforming teaching to strengthen health systems in an interdependent world. Lancet. 2010;376:1923–1958. doi: 10.1016/S0140-6736(ten)61854-5. [PubMed] [CrossRef] [Google Scholar]

37. Clan of American Medical Colleges . Behavioral and Social Scientific discipline Foundations for Time to come Physicians. Association of American Medical Colleges; Washington, DC, United states: 2011. [Google Scholar]

38. Kaplan R.Grand., Satterfield J.M., Kington R.Southward. Building a Better Physician—The Case for the New MCAT. Due north. Engl. J. Med. 2012;366:1265–1268. doi: ten.1056/NEJMp1113274. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

39. Institute of Medicine . Crossing the Quality Chasm: A New Health System for the 21st Century. 2nd printing ed. National Academies Press; Washington, DC, U.s.: 2001. [Google Scholar]

41. National Establish for Health and Intendance Excellence (NICE) Nice Guidelines [NG43]. Transition from Children'due south to Adults' Services for Young People Using Health or Social Care Services. [(accessed on 17 July 2017)]; Available online: https://www.nice.org.britain/guidance/ng43

42. Wade D.T., Halligan P.W. The biopsychosocial model of illness: A model whose time has come. Clin. Rehabil. 2017;31:995–1004. doi: 10.1177/0269215517709890. [PubMed] [CrossRef] [Google Scholar]

43. Kirian 1000., Sears S.F., DeAntonio H. Sudden Cardiac Arrest: A Biopsychosocial Approach to Patient Management of Ventricular Fibrillation and Implantable Cardioverter Defibrillators. In: Dornelas E.A., editor. Stress Proof the Heart. Springer; New York, NY, USA: 2012. pp. 25–43. [Google Scholar]

44. King A. Making connections for a biopsychosocial future in cancer care. Future Oncol. 2016;12:2767–2769. doi: 10.2217/fon-2016-0463. [PubMed] [CrossRef] [Google Scholar]

45. Crosby 50.E., Quinn C.T., Kalinyak M.A. A Biopsychosocial Model for the Management of Patients with Sickle-Cell Disease Transitioning to Adult Medical Intendance. Adv. Ther. 2015;32:293–305. doi: ten.1007/s12325-015-0197-ane. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

46. Ayers D.C., Franklin P.D., Ring D.C. The Role of Emotional Health in Functional Outcomes after Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics. J. Bone Jt. Surg. Am. 2013;95 doi: 10.2106/JBJS.L.00799. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]

47. Edozien Fifty. Beyond biological science: The biopsychosocial model and its awarding in obstetrics and gynaecology. BJOG Int. J. Obstet. Gynaecol. 2015;122:900–903. doi: 10.1111/1471-0528.13328. [PubMed] [CrossRef] [Google Scholar]

48. Webb J.A., Kamal A.H. Integrating the biopsychosocial model into quality measures in palliative care: A case for improving the hospice particular set. J. Pain Symptom Manag. 2014;48:e1–e2. doi: x.1016/j.jpainsymman.2014.05.002. [PubMed] [CrossRef] [Google Scholar]

49. Geraghty One thousand.J., Esmail A. Chronic fatigue syndrome: Is the biopsychosocial model responsible for patient dissatisfaction and impairment? Br. J. Gen. Pract. 2016;66:437–438. doi: 10.3399/bjgp16X686473. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]

50. Dodge Thou.A., Pettit Thou.S. A Biopsychosocial Model of the Development of Chronic Conduct Issues in Adolescence. Dev. Psychol. 2003;39:349–371. doi: 10.1037/0012-1649.39.ii.349. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

51. Christie D., Viner R. Abc of Adolescence: Adolescent Development. Br. Med. J. 2005;330:301–304. doi: ten.1136/bmj.330.7486.301. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

52. Kennedy A., Sawyer S. Transition from pediatric to adult services: Are we getting information technology correct? Curr. Opin. Pediatr. August. 2008;xx:403–409. doi: x.1097/MOP.0b013e328305e128. [PubMed] [CrossRef] [Google Scholar]

53. Klein J.D., Slap Thou.B., Elster A.B., Schonberg S.K. Access to wellness treat adolescents. J. Adolesc. Health. 1992;13:162–170. doi: 10.1016/1054-139X(92)90084-O. [PubMed] [CrossRef] [Google Scholar]

54. Farre A., Wood V., Rapley T., Parr J.R., Reape D., McDonagh J.E. Developmentally appropriate healthcare for young people: A scoping study. Curvation. Dis. Child. 2015;100:144–151. doi: ten.1136/archdischild-2014-306749. [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]

55. Globe Health Organisation . The 2d Decade: Improving Boyish Health and Development. World Wellness Organization; Geneva, Switzerland: 2001. [Google Scholar]

56. Lugasi T., Achille M., Stevenson M. Patients' perspective on factors that facilitate transition from child-centered to adult-centered health care: A theory integrated metasummary of quantitative and qualitative studies. J. Adolesc. Health. 2011;48:429–440. doi: 10.1016/j.jadohealth.2010.ten.016. [PubMed] [CrossRef] [Google Scholar]

57. Farre A., Forest V., McDonagh J.E., Parr J.R., Reape D., Rapley T. Transition Collaborative Group. Wellness professionals' and managers' definitions of developmentally appropriate healthcare for immature people: Conceptual dimensions and embedded controversies. Curvation. Dis. Child. 2016;101:628–633. doi: 10.1136/archdischild-2015-309473. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]

58. Goldenring J.M., Cohen E. Getting into adolescent heads. Contemp. Pediatr. 1988;five:75–90. [Google Scholar]

59. Goldenring J.M., Rosen D.S. Getting into boyish heads: An essential update. Contemp. Pediatr. 2004;21:64–90. [Google Scholar]

60. Klein D.A., Goldenring J.Thousand., Adelman W.P. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. Contemp. Pediatr. 2014;31:sixteen–28. [Google Scholar]

61. Doukrou Yard., Segal T.Y. Fifteen-minute consultation: Communicating with young people—How to use HEEADSSS, a psychosocial interview for adolescents. Arch. Dis. Child. Educ. Pract. 2017 doi: x.1136/archdischild-2016-311553. [PubMed] [CrossRef] [Google Scholar]

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