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The biological aspect in biopsychosocial model play its major role by helping us understanding more on how the cause of illness can affect the functioning of individual body. On the other hand, the psychological aspect is used in looking for potential of psychology that can cause of health problem such as negative thinking while the social aspect of takes part on how differences of social factors can affect individual's health. For examples, influence of individual's health such as diabetic and hypertension as well as culture.
The biopsychosocial model is different compared to biomedical model. The biomedical model has been well defined as a concept in which the body "is conceptualized as a machine in which all the parts functioning together to ensure health. If some parts broke down, clinicians intervened to limit and treat damage." Its ultimate objective is on curing the disease and not as the whole person. Its also generally consists of seeking to identify "single, very specific causes of illnesses" and responding with specific treatments, such as antibiotics for infection (Jones,1994). Moreover,the biomedical model only concentrating on biological aspect of patient. On the other hand, the biopsychosocial model concentrating on the biological, psychological and sociological in order to treat a patient.
During two weeks of first clinical placement in the government hospital, the biopsychosocial model has been applied in the physiotherapy department. Some of the cases that referred to the physiotherapy department by the orthopaedic department (OOPD) is cervical spondylosis. The cervical spondylosis is usually affects the vertebrae C1-C7 and T1. In most of the spondylosis cases C4-T1 vertebrae are subjected to spondylosis (Irudayaraj 2007). Cervical spondylosis could be occur due to increase onset with ageing but may accelerated by cummulative trauma, poor body mechanics, postural changes or previous disk injury (Gulick,2005).
One of the cases that is referred by the orthopaedic department involving Mr X as the subject. Mr X is a 46 years old male, working as a long distance lorry driver currently used to work as a navy formerly.Mr X has been diagnosed by the physician that he had a cervical spondylosis.
Mr.X met Mrs.H is a physiotherapist that responsible for Mr X cases after referred by a physician to the physiotherapy department.. Mrs H greeting Mr X by saying "good morning and please seat". The first communication with patient is important because communication is defined as the transmission of information, thoughts and feeling of the patient to physiotherapist so that they are satisfactorily received or understood about what kind of treatment or person whose treat them. Mrs.H start the subjective assessment by asked the question to the patient. Subjective assessment is information that gathered from the patient and from their medical notes such as X-ray. According to Maitland et al (2001), the clinician(physiotherapist) should speak slowly and deliberately, keep question short and ask only one question at time Petty( 2006,p.6).
The subjective assessment start with Mr.X complain have a pain around the neck and sometimes feel stiffness especially after wake up from bed and when drive for a long time because of his work as a long driver. Mrs.H asked if the pain disturb him during the movement of the neck. He said only went he stretched it to much. Pain is an unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease or emotional disorders(Mifflin,2007).Then Mrs.H show what type of position of the pillow during he sleep at the night and tell the correct position of the pillow by drawing it on a piece of paper so Mr.x can understand more and participate during the process, in way to help reduce the pain that Mr.X feels. From subjective assessment Mrs.H know that Mr.X already feel a same pain a several years ago but not worse as today.
Later, Mrs.H start the objective assessment.Objective assessment is to determine what structure(s) and/or factor(s) are responsible for producing the patient's symptoms Petty(2006,p.37). Mrs.H examinate around Mr.X neck especially around the pain area by observed the spinal posture of head and neck and passively corrects any asymmetry to determine its relevance to the Mr.X problem and found that Mr.X also had upper crossed syndrome,where there is elevation and protraction of the shoulders, rotation and abduction of the scapulae and forward head postureJanda(2002 p.182).During this procedure, Mrs.H communicate with Mr.X by asking "feel any pain?, Where you feel uncomfortable?, "Are you ok?". These all because to make sure Mrs.H do not move the cervical vertebrae more than the normal range because it may lead to another problem. Just not that, during these procedure Mrs.H also observe the quality of movement, range of movement, and provocation of any muscle spasm and tells all to Mr.X so Mr.X know what Mrs.H been doing to him because Mr.X had a right to know the course of illness.
After done with objective assessment, Mrs.H discuss the treatment with Mr.X. According to the principle of patient autonomy, competent patients have the right to self-rule and to choose among medically recommended treatment and refused any treatment they do not want(libraryindex,2010). The treatment that suggest to Mr.X by Mrs.H are hot pack, deep tissue massage(manipulation) and some exercise. Hot pack is used to increase blood flow to the area, along with increased levels of oxygen and nutrition(Hoyle,1999-2010).Mrs.H put the hot pack at the neck and tell Mr.X that the hot pack must feel warm and not hot. If to hot in may danger to the patient so Mrs.H make sure that she wrap the moist hot pack with several layers of towel. After 15 minutes, Mrs.H continue treatment with deep tissue manipulation. During these procedure, Mrs.H always talk to Mr.X by asking "How you feeling right now?, Are you comfortable?" . These because Mr.X make a expression that he feel so pain and not comfortable or tolerate with the pain. So Mrs.H stop the treatment for a while and let Mr.X rest before start it again. Patients' facial expression are often a good indicators of sadness, worry or anxiety. The physician who respond with appropriate concern to these nonverbal cues will likely impact the patients' illness to a greater degree than the physician wanting to strictly convey factual information (M,Travaline, Ruchinskas, D'Alonzo,2005). After Mr.X feel fine, Mrs.H start the massage again and tell Mr.X "You done a great job". These is need to make sure Mr.X want to continue the treatment in way to feel better again and achieve the goal. After that, Mrs.H continue with stretching exercise. For stretching exercise Mrs.H demonstrate to Mr.X so he can understand it and easy for him to do it. After demonstrate it Mrs.H ask Mr.X to do it. During Mr.X do the exercise Mrs.H encourage Mr.X by said "You can do it and good job".
Mr.X feel anxiety if the pain from the illness that he get may disturb him when he do his job. Therefore, Mrs.H tell Mr.X when he feel pain, he can do the stretching that Mrs.H thought before to release the tension around the neck. According to Fordyce and Steger (1979), the successful treatment of the pain then decreasing the pain, which subsequently decrease the anxiety . This can then cause a further decrease in the pain level.Naidoo and Wills(2008,p.163). Moreover, during these session Mr.X come by himself without any family members accompany him so Mrs.H must make sure that Mr.X understand all the exercise that she taught so Mr.X can do it by himself.
As a conclusion, by practise the biopscychosocial model,help physiotherapist a lot in way to treat patient. Physiotherapist can identify which factor that aggravate the pain or illness. It also helps the patient understand more about the source of illness and can avoid or reduce it. Through these model it increase patient self-efficacy. According to Bandura(1977), self-efficacy to reflect the extent to which people feel confident that they can do whatever it is they wish to do Naidoo and Wiils(2008,p.155). These happen because Mrs.H always support and encourage Mr.X during the treatment and make Mr.X belief that he can do it and treat the illness.