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- Page navigation anchor for Epistemology, politics, emotions and counter transference: Around �The Biopsychosocial Model 25 Years Later: Principles, Practice and Scientific Inquiry�.Epistemology, politics, emotions and counter transference: Around �The Biopsychosocial Model 25 Years Later: Principles, Practice and Scientific Inquiry�.Show More
The excellent and well-documented work presented by doctors Borrell- Carrió, Suchman, and Epstein (1) has the merit to introduce rigorously and radically the discussion about the current prevalence and validity of the model proposed by Engel 25 years ago. Thus, since the work merits it, and without trying to be too systematic in my commentary, I would like to add a series of contributions.
First, I think that tod...
Competing Interests: None declared. - Page navigation anchor for Response to Dr FarleyResponse to Dr FarleyShow More
In response to Drs. Borrell-Carrio, Suchman, and Epstein's request for "quotations from other authors...to verify our hypothesis that the biopsychosocial model began as a perceived need in many places simultaneously" -- I hereby submit one of my personal favorites. It comes from outside the clinical realm, but the ironic tone does seem to resonate, nowadays:
"It is fortunate that the Good Lord created the unive...
Competing Interests: None declared. - Page navigation anchor for Reflecting on Our Own Biopsychosocial ProgressReflecting on Our Own Biopsychosocial ProgressShow More
I very much appreciated this article. For many of us, biopsychosocial practice is still the very definition of who we are as family physician generalists and a necessary paradigm for truly patient- centered care (yes I think it is a new paradigm). This article certainly goes a long way in reminding us of our roots, eliciting many of the difficulties encountered along the way both philosophical and practical, and tying...
Competing Interests: None declared. - Page navigation anchor for Magnificent Article!Magnificent Article!Show More
I believe that Dr. Borrell-Carrió et.al. have provided us with a beautiful summary and discussion of the issues which are part of the currrent paradigm shift in medicine that continues to gain momentum. The authors and this journal have done an immense service by developing and publishing this article.
We are all familiar with laments about the failures and high costs of modern medicine, and the evils of manage...
Competing Interests: None declared. - Page navigation anchor for Response to Drs Medalie, Sturmberg and GreenResponse to Drs Medalie, Sturmberg and GreenShow More
While we share Dr Medalie's skepticism about complexity science, it has become the lingua franca of theorists of family medicine, and thus deserves some mention; it would be conspicuous by its absence. In our (ALS and RE) conversations with George Engel in his later years, his view of biopsychosocial models seemed to evolving in that direction. If there are any further benefits to adding another set of jargon to the alrea...
Competing Interests: None declared. - Page navigation anchor for more family physicians in Brazilmore family physicians in BrazilShow More
Interesting article. It is an important reflection concerning the future of the family medicine. Here in Porto Alegre, in the Rio Grande Do Sul, Brazil, since of 1974, we are with a proposal of comprehensive attention to the patient. With register in handbook of Family, work in team, territorial area of responsibility of the team. For such, since 1976, o Murialdo Health Center it initiated one of the pioneering progra...
Competing Interests: None declared. - Page navigation anchor for A Sense of Imminent ProgessA Sense of Imminent ProgessShow More
I had the good fortune of being a family medicine resident in Rochester under Gene Farley's visionary leadership and also to just happened to be in the family medicine center during a few weeks when George Engel was there, directly observing in real time the doctors and patients in their consultations. He permitted me to watch him watch--and I have said on occasion that I learned more about caring for patients from his o...
Competing Interests: None declared. - Page navigation anchor for Progressing Engel's biopsychosocial model of healthProgressing Engel's biopsychosocial model of healthShow More
"We are not students of some subject matter but students of problems. And problems may cut right across the borders of any subject matter or discipline." (K.Popper, 1972)1
It is refreshing to see that Engel’s biopsychosocial model of health care hasn’t lost its appeal, at least to some. However, shouldn’t a retrospective also elaborate on what else has developed since? We feel that Engel responded to the thin...
Competing Interests: None declared. - Page navigation anchor for Comment on "The Biopsychosocial Model 25 Years Later..."Comment on "The Biopsychosocial Model 25 Years Later..."Show More
Approximately 25 years ago, George Engel brilliantly conceptualized the comprehensive approach to medical diagnosis and treatment in what became known as the Psychosocial model.
The authors Borrell-Cario, Suchman and Epstein in a very interesting article, pay tribute to Engel and at the same time, proceed to fine-tune and detail certain aspects of the model. Are they splitting hairs, or adding to our understan...
Competing Interests: None declared. - Page navigation anchor for Response to Drs Spenser and SchergerResponse to Drs Spenser and SchergerShow More
Response to Drs Spencer and Scherger
Drs Spencer and Scherger remind us that the “proof is in the pudding.” This article was about theory, which hopefully will be of some use in highlighting the strengths of prior innovations and in informing new practices. The problem-oriented record is one such innovation. Dr Scherger advises us of the limitations of brief face-to-face meetings with patients that currently co...
Competing Interests: None declared. - Page navigation anchor for Response to Dr Shmuel ReisResponse to Dr Shmuel ReisShow More
Response to Dr Reis:
Dr Reis points out the disappointing efforts to incorporate promised new paradigms of health care, including evidence-based medicine, a biopsychosocial approach and, more recently, complexity theory (and, to add, narrative-based medicine, family-oriented primary care, community- oriented primary care and others). This is true even in domains where several such paradigms converge to provide t...
Competing Interests: None declared. - Page navigation anchor for Response to Professor Diego Gracia.Response to Professor Diego Gracia.Show More
Response to Professor Gracia
Professor Diego Gracia highlighted several importants points, not always recognized in the biopsychosocial literature. We thank him for the opportunity to expand upon some ideas. The first point Professor Gracia introduces is the lack of philosophical interest of biopsychosocial model. Historically, Engel was a clinician first, and based his model on empirical observation; philosophi...
Competing Interests: None declared. - Page navigation anchor for Response to Dr FarleyResponse to Dr FarleyShow More
Response to Dr Farley
We appreciate very much Dr. Farley’s contribution to the discussion of the biopsychosocial model. It is interesting to note that in Spain, at the same time as Dr Engel was elaborating his model, others (such as Drs Gol i Gurina, Tizón, Casares, and Ramis) were thinking in a similar way. Here are two quotes from Dr Gol i Gurina:
“The ill person achieves a state of health not with...
Competing Interests: None declared. - Page navigation anchor for Tools for the jobTools for the jobShow More
Borrell-Carrio, Suchman and Epstein’s “The Biopsychological Model 25 Years Later:…” was a much needed and timely contribution and should be read by all medical students and young physicians. What I missed in the article and in the comments so far (apart from a hint by Scherger)was any mention of “tools” to facilitate the practice of BPS medicine – past, present and future.
I still think that to date the best – ma...
Competing Interests: None declared. - Page navigation anchor for A New Model of Family Medicine is needed to reactivate the Biopsychosocial ModelA New Model of Family Medicine is needed to reactivate the Biopsychosocial ModelShow More
Brief office visits are not conducive to practicing the biopsychosocial model or relationship-centered care. The productivity targets of visits per shift and RVUs simply have family physicians racing through patient visits, and make the philosophy expressed in this excellent article a pipe dream. I believe that a new model of family medicine can be much more biopsychosocial and relationship centered when we provide co...
Competing Interests: None declared. - Page navigation anchor for Welcome contributionWelcome contributionShow More
Borrel-Carrio, Suchman and Epstein are making the bold leap of trying to take stock of Engel's work over 25 years after it has been written up and gained a widespread recognition. Their paper lends a panoramic view, almost breathtaking, while integrating new and deep approaches that have emerged since Engel. I enjoyed reading it and found it valuable both as a state-of the art summary and as a springboard for further el...
Competing Interests: None declared. - Page navigation anchor for Engel's LegacyEngel's LegacyShow More
Borrell-Carrió, Suchman, and Epstein begin their article with the statement that Engel’s biopsychosocial model “is both a philosophy of clinical care and a practical clinical guide.” My personal impression has always been that Engel’s contribution has been much more important in the clinical level than in the philosophical one. And reading the paper of the authors I concluded that they are also of the same opinion. Nowada...
Competing Interests: None declared. - Page navigation anchor for Perambulations on: �The Biopsychosocial Model 25 Years LaterPerambulations on: �The Biopsychosocial Model 25 Years LaterComments on: “The Biopsychosocial Model 25 Years Later It was enjoyable both reading and responding to this article. My comments are more about my mental perambulations stimulated by reading the article, than they are to specific analysis of comments on any one point of the article. Discussions with people or reading articles gets my mind to “wonderings and wanderings” - expansions stimulated by the subject at hand. My comm...Show MoreCompeting Interests: None declared.