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Supremacy of the Biopsychosocial Model of Health Over the Biomedical Model of Health
Introduction
Various approaches to rehabilitation based on scientific models are implemented to cope with disabilities, impairments, and diseases (Lorenzo, M, 1999, p.1). Before the implementation of the Biopsychosocial model, the Biomedical model was traditionally practiced and heavily used in assessing patients (Engel, 1977, p.130).
Engel (1977, p.131) states that the biomedical model “illustrates the alteration of particular biochemical is commonly assessed in a specific diagnosis is relevant to the pattern of the disease”. He also mentioned that additional concepts and frames of reference should be taken into account.
The biopsychosocial model is said to be an improved model than the biomedical model as it is a way of examining patients at the two important interlinked systems: mind-body connection. (Engel, 1977, p.132). This model was proposed by psychiatrist George Engel in a 1977 article in Science. This biopsychosocial model treats patients from biological, psychological, and sociological aspects of the body (Lakhan, 2006). Unlike it, the biomedical model solely examines the biological aspect (Erskine et al, 2003, p.173).
The most obvious dissimilarity between the Biopsychosocial model and the Biomedical model is that the Biopsychosocial model encourages patient active participation whilst the Biomedical model is not much a model which promotes patient-centered care in terms of appreciating the individual needs and rights of patients, understanding patients’ illness and health care experiences and embracing them within effective relationships which enable patients to participate in clinical reasoning more (Ersser, 2008, p.68).
Application of the Biopsychosocial Model in Clinical Placement
The biopsychosocial model approach was used during a clinical placement; Mdm. C went for her first treatment in the physiotherapy department after being referred case from an orthopedics doctor to a physiotherapist. Mdm. C is a 56 years old housewife who is diagnosed with shoulder osteoarthritis. Shoulder osteoarthritis typically affects patients over 50 years old and it is more common in patients who have a history of a prior shoulder injury as well as genetic predisposition (Cluett, 2009).
Mdm. C was having a language barrier with the physiotherapist responsible, Mr. S as she is incompetent in speaking English and Malay. Immediately, Mr. S finds another assistant who is able to communicate with her in Mandarin (Chinese).
Despite the barrier faced, Mdm. C was greeted nicely by Mr. S. Based on the physician’s report, Mdm. C’s condition fulfilled the symptoms of shoulder osteoarthritis: inflammation and degeneration of cartilage, pain with activities, limited range of motion, stiffness of the shoulder, swelling of the joint, tenderness around the joint, and a feeling of grinding or catching within the joint (Cluett, 2009). Both objective and subjective assessment is carried out to initiate the treatment as well as to identify and confirm the biological aspects. (Petty, 2004)
While assessing Mdm. C subjectively, Mr. S communicates with Mdm. C whole-heartedly, questioning her about her background, her career, social life, and daily habitual routines. Petty and Moore (2007, p. 130) state that “this would ease the physiotherapist to investigate more about the initial cause of the deformity as well as to treat her effectively in achieving the short-term and permanent goal in rehabilitation”.
Physiotherapists practiced active listening while listening with a heart of compassion, and patience and without any judgmental view. Physiotherapists should also choose words carefully and meaningfully without stepping into the patient’s borderline by using open-ended questions to search for information until full understanding is achieved. Sensitive verbal and non-verbal communication is witnessed throughout the session (Petty and Moore, 2007, p.130).
Physiotherapist’s attempt to enquire more about Mdm. C is successful as Mdm. C became more comfortable in exposing and describing more about her complaints of pain. This indirectly allows the physiotherapist to gather more information for a better rehabilitation outcome at ease. Engel (1977, p.130) states that ‘more information needs to be gathered during the consultation as physiotherapists need to find out about the patient’s biological signs, psychological state, their feelings and beliefs about the illness, and social factors such as their relationship with families and the larger community.’
Thus, the interview process acts as a means for the patient to give as much information as possible not solely based on physical symptoms, but on how the illness affects the patient. (Engel, 1977, p.130). The physiotherapist started the objective assessment with the examination of the posture of Mdm. C in sitting and standing, noting the posture of the shoulders, head and neck, thoracic spine, and upper limbs. The physiotherapist notes bony and soft tissue contours around the region. He checked the alignment of the head of the humerus with the acromion as this can give clues about the possible mechanical insufficiencies.
Mr. S pinch-grips the anterior and posterior aspects of the humerus, and passively corrects any asymmetry to determine its relevance to the Mdm. C’s problem (Petty, 2006, p. 212). Objective assessments are accompanied by other tests and after all been carried out, Mr. S had drafted out the treatment plan for Mdm. C.
Mr. S then carefully and slowly explained the treatment to Mdm. C and set a short-term goal for her as it would not be a burden for Mdm. C in short duration. Mdm. C also benefits from getting a better idea of her conditions, treatment alternatives, and expected improvements. Sullivan (2007, p.11) states that the “anticipated goal and the expected outcome can address in predicted change in overall health, risk reduction, and prevention and optimization of patient satisfaction.”
He also states that this would further encourage faster recovery. Mr. S then applied hot packs on Mdm. C’s shoulder as heat helps to prepare the tissues for stretching and should be performed prior to any exercise sessions (Anderson, 2009). Time duration of 10-15 minutes are used for the treatment and several layering were used to wrap to hot pack to avoid burning of the skin. Thermo therapy is believed to relax muscle tightness and relieve pain, reduce muscle spasm, and increases blood circulation (Inverarity, 2005).
Mr. S then teaches Mdm. C simple exercises to facilitate her restricted movements. Before starting the treatment, Mr. S demonstrated the exercise slowly and gave short, clear, and easy-to-understand instructions and explanations about the treatment without using scientific jargon and labels to enhance the understanding of Mdm. C as well as to minimize the emotional distress (O’ Sullivan and Precin, 2007, p.56).
This takes the patient’s empowerment into account as the physiotherapist informed and explained the treatment options to the patient before commencing the exercising patient herself. The exercises given are finger walk, towel stretch, and armpit stretch. The goal of these exercises is to stretch the shoulder to the point of tension without pain (Anderson, 2009).
Mr. S monitored Mdm. C’s psychological aspects properly by observing Mdm. C’s facial expression and body language. Facial expressions act as an indicator of a patient’s psychological affection(Petty, 2004). It would somehow affect the quality of exercises performed by the patient. Observing patients’ facial expressions, tell physiotherapists how they are feeling while doing exercises and whether they are comfortable doing it or not (Petty, 2004).
For instance, if Mdm. C feels like giving up due to fatigue and disappointment doing exercises, Mr. S would act as a motivator to motivate her to continue her efforts by encouraging and supportive words like, “Don’t stop, you’re almost there”, “Keep going, you’re doing very well”, “You can do it, it’s easy”, “Hang in there, just a while more”, “You’re doing very good, come let’s finish it together”, this indirectly would comfort the patient’s psychological discomforts and motivate her to be on the right track.
Mr. S enquired again if Mdm. C is comfortable with the given exercises to ensure that Mdm. C knows what she is doing and why is she feeling this way, and how she copes with it if she feels like giving up due to tiredness. These covered the psychological aspects (Petty and Moore, 2007, p. 131).
Though Mdm. C came alone for this treatment, she was encouraged by both Mr. S and his assistant who are competent in Mandarin throughout the session. Thus, Mdm. C knows that she is not doing it alone. When the treatment session is over, Mr. S gave Mdm. C few sheets of paper containing the exercises she did earlier. Mr. S contacted Mdm. C’s nearest kin, her daughter to stress the importance of home exercises and ensures that Mdm.
C constantly does that at home, as well as encourages the family members to participate in the exercises in helping Mdm. C to improve her muscle strength and relieve the symptoms. Mr. S educates the family members about precautions and safety at home. Mr. S strongly encouraged family members to accompany Mdm. C for her next scheduled treatment so as to overcome the language barrier and to make the family involved. These cover the sociological aspects of treatment. Sullivan, (2007, p. 52) states that ‘Social support helps the increased of self-esteem, adjusting and adapting oneself with disability.’
Conclusion
The biopsychosocial model takes into consideration the patient’s involvement in treatment, the patient’s needs, and patient relationship with a clinician during clinical practice as this model comprises the biological, psychological, and sociological aspects of a patient. To conclude, the biopsychosocial model is practical, applicable, and agreeable as it brings enormous improvements to a patient’s condition.
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