One might ask what the Biopsychosocial Model (BPS), better known in layman's term as the Holistic Model is, or why it is better than the previous Biomedical Model. The answer maybe found by quoting the founder of the BPS model Dr. George L. Engel (Engel 2007);
“To appreciate relationship and dialogue as requirements for scientific study in the clinical setting highlights the natural confluence of the human and the scientific in the clinical encounter itself. It is not just that science is a human activity, it is also that the interpersonal engagement required in the clinical realm rests on complementary and basic human needs, especially the need to know and understand and the need to feel known and understood . The first, to know and understand, ... is a dimension of being scientific; the second, to feel known and understood, is a dimension of caring and being cared for. Both may be seen as derivative and emergent from biological processes critical for survival.... The need to know and understand originates in the regulatory and self-organizing capabilities of all living organisms to process information from an ever changing environment in order to assure growth,... self-regulation, and survival. In turn, the need to feel known and understood originates.... in the life-long need to feel socially connected with other humans.... The need to know and to understand ultimately achieves its most advanced development in the disciplined curiosity that characterizes scientific thinking. The need to feel known and understood manifests itself in the continuity of human relationships and in the social complementarities between perceived helplessness and the urge to help. Herein then converge the scientific and the caring (Samaritan, pastoral) roles of the physician.”
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This summarises the very foundation of the BPS Model, from which many questions can be answered.
Dr. Engel being a medical practitioner himself could see that the Biomedical Model was insufficient to empower the patients. The Biomedical Model only takes into account the medical health of the patient. So long as the patient is not sick or dying the patient is considered healthy, however the meaning behind the empowerment of a patient is for the patient to make choices, whether it is about the treatment or about his social lifestyle or just about the environment that brings a big influence to his health. The Biomedical Model says that a person is healthy if one or more of the 5 D s (death, disease, disability, discomfort, and dissatisfaction) are absent (Edlin 1997), however for a patient to be thoroughly empowered the patient has to bring about changes to his very lifestyle. Whether it is to the place he lives or his social life the patient has to be able to make the right changes to truly attain a healthy lifestyle. ( Gohde 2002) This discussion will be using Mr. X a stroke patient going for rehabilitation at a hospital to further explain the BPS Model that has just been mentioned above.
Mr. X a 43 year old man was admitted to the hospital on the account of having suffered a stroke. Mr. X had, had three minor strokes before, but he put it of as something minor until the recent attack. His family members urged him to go for a full body check up, Mr. X put it off again as something not important and went on with his lifestyle as an active businessman. Mr. X always said that time equals money and therefore had no time to spare on going for regular body check up. Ms. P a physiotherapist after hearing his history told him that money is not everything and he was fortunate that his son was around to bring him to the hospital. Ms. P told him that to be truly fit a person not only has to exercise and has to have a healthy diet he also has to be mentally and spiritually sharp. Keeping with the BPS Model Ms. P then proceeded to ask Mr. X a few questions related to his social lifestyle, the environment he lives in and how he is feeling right at that moment. While she was asking these questions Ms. P was quietly observing the patient's movement and facial expression. It was found through the questions and the doctor's report that Mr. X is having a hard time controlling the left side of his body. Ms. P explained to the patient that it is normal after a stoke to suffer weakness in one or both sides of the body. She then reassured Mr. X that by doing a few strengthening exercises he would soon be able to regain the movements of his body back to near normal conditions.
Ms. P then proceeded to palpate the affected area to see if Mr. X still felt any pain. As Mr. X was supported by his son the day he got attack he suffered no secondary complications. Ms. P then started to measure the active and passive range of movement (ROM) of Mr. X using a goniometer. The measurements taken were the movements of the upper limb (shoulder, elbow, and wrist) and lower limb (hip, knee, and ankle) of the affected area. It was found that Mr. X had very little active ROM but had retain the full passive ROM. She then went on measuring the muscle strength of Mr. X's upper and lower limbs. After doing the assessments she explained to Mr. X that the left side of his body had to regain the strength that it had prior to the stroke. She then proceeded to explain to Mr. X her plan of treatment, and when he understood the plan and was fine with it, she proceeded to do the sensation test and then gave him a hot pack treatment. By explaining to Mr. X her plan of treatment Ms. P shows that she was following the BPS Model. After that Ms. P taught Mr. X a few exercises to strengthen his muscles such as reaching for a pen and lifting his left leg. Ms. P main aim in this task oriented approach was to promote “functional induced recovery” (O'Sullivan, 2007). She also taught his family members simple exercises so that they would be able to guide him through and encourage him. Ms. P encouraged his family to be there for him. According to Galvin (2009), for psychological purposes, the best method of delivery of stroke care is the involvement of family members as this will enhance maximal recovery.
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Mr. X was fortunate to have his family to encourage him, Ms. P noticed huge progress in Mr. X. In a few days Mr. X showed huge increase in his active ROM and also his muscle strength. Ms. P then recommended that Mr. X use a tripod to practise walking. She showed Mr. X how to use the tripod and assisted him. She also educated the family on how to assist Mr. X on using the tripod. She then asked Mr. X about his living place. Ms. P was applying the Model here by taking in to account his social live style. Mr. X lives in an apartment on the 29th floor with his wife and two out of his five children. His wife is a housewife while his two children are still studying. His wife tells Ms. P that Mr. X sleeps on the second floor as their apartment had two floors. Ms. P then suggested that they moved his room to the lower floor to reduce the times Mr. X has to go up the stairs as he was using a walking stick. Mr. X had no problem moving around the house because the floors are all levelled and the equipment around the house is easily accessible. The apartment also comes with elevators services so Mr. X has no problem going to the 29th floor of the building. His wife also said that the balcony came with a high railing therefore there was little chance for Mr. X to lose his balance. After a week of treatment Mr. X was capable of executing normal activities and could look after himself.
Ms. P also inquired about Mr. X's work place. Mr. X is a managing director of a huge company. He said that the company facilities were accessible to impaired workers. The company has elevators and the equipment is easily accessible. He also mentioned that he had a personal secretary in the office to assist him in his work. As Mr. X is right hand dominant he has no problem writing though he might find it slightly difficult to type. Ms. P encouraged Mr. X to continue doing the arm and hand exercises and well as some finger exercises to strengthen his arm so that he should not suffer much difficulty in typing. Mr. X also likes to read in his spare time and does not play much sport. Ms. P suggested to Mr. X to take long walks in the evening with his wife to strengthen his muscles. After spending a few weeks in the hospital Mr. X was discharged but made appointment to go for therapy sessions in the out patient department. He also took a month worth of leave to rehabilitate at home.
In conclusion, Ms. P showed that she practises the BPS Model which takes into account the physical, mental and social aspect of the patient. The patient should feel that he is given the choice in his treatment and also that he understands the treatment given to him. By covering all aspects of the patient's life the therapist can ensure that the patient is being empowered. The communication between the patient and the therapist is also very important in executing this Model. From this experience it can be demonstrated that the BPS Model is a more rounded Model in comparison with the Biomedical Model.
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