Article review: “Biopsychosocial Model – The integrated approach to health and disease” by Havelka, Lucanin & Lucanin (2009)

In this article, Havelka et al point out that the biomedical model was a valid model while infectious diseases caused by one factor prevailed and were the main healthcare problem for humanity, but now that chronic, lifestyle & non-infectious diseases with multiple influencing factors are the main health issue it is no longer effective or appropriate as the default model for healthcare. They are in favour of the biopsychosocial (BPS) model and say its implementation is taking too long. Their criticisms of the current biomedical model are:

• the dehumanisation between healthcare staff and patients
• continual improvement of increasingly advanced medical techniques leading to a rise in expenditure where only rationing of healthcare would allow for the continuation of technology-led healthcare (as opposed to psycho-social led)
• reductionist i.e. reduces people to the smallest component -their cells- and separates mind and body in order to do this despite evidence to the contrary

How does sociology and culture affect occupation throughout someone’s life?

Sociology is the study of human social life, groups, and societies (Giddens et al 2013:4). The type of society around us greatly influences our thoughts and actions whether we are aware of it or not. How does our behaviour (what we think, feel and say) as social creatures influence or affect the occupations we choose, and how we carry them out? Sociology can help OTs to understand whether something is a social/public issue, or a personal problem.

Sociology is the study of groups’ behaviour

Some prominent sociological theorists are Durkheim, Marx and Weber. Emile Durkheim studied the effects of capitalism on increased suicide rates in the newly industrialised European countries. He attributed this to:

1. increased individualism where rewards from good decisions are enjoyed by the individual alone, but so too are the consequences of bad ones. Previously the blame would be shared between other members of a family or group because the decision on whether to become say, a baker, was influenced by family tradition or the need for a baker in the village, rather than someone’s individual choice to strike out and open a patisserie in Hull.
2. too much aspiration and subsequent disappointment when what is theoretically possible isn’t achieved. What we have isn’t actually all that bad but when compared to Khloe Kardashian, our life is a turdburger.
3. too much freedom meaning there aren’t the same connections to other people as there used to be when social norms were around to tell us who to marry, what to do on a Sunday  or how much ankle to show. People can often feel more anonymous and less connected now as a result of increased personal freedom.
4. increased atheism – while religions are based on questionable facts with a propensity for inciting prejudice and war, they do offer an important sense of community and shared experiences to draw people together; something capitalism doesn’t offer a replacement for.
5.  decrease in national pride and family – national identities and family ties are more diffuse and no longer give people the feeling they are part of something bigger than themselves.

Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Chronic conditions (such as COPD or diabetes) are increasing in Western countries like England and Holland. These long-term conditions need the patient to be active in managing their condition in order to achieve reduced financial healthcare burden and better quality of life for the patient.

In this way, evidence shows that a biopsychosocial model would benefit patient well-being and produce these financial improvements. However provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system.

So the biopsychosocial model is a great idea – how to implement it?

Article review: “The role of mental health professionals in multidisciplinary pain rehabilitation programs” by Townsend et al (2006)

Townsend et al (2006) write that traditional roles of psychologists are being challenged by the Multi-Disciplinary Team (MDT) treatment now required in order to treat patients with chronic pain according to the biopsychosocial model.

MDT: Team Otter

Treatment of chronic pain was traditionally carried out according to a biomedical model- a patient after a car accident was treated for chronic pain syndrome but not assessed for PTSD, for example. Research has shown the efficacy of a biopsychosocial model in treating  pain, where social and psychological factors as well as biological are taken into account. Turk (2002) reported patient benefits of the biopsychosocial approach (with regards to chronic pain) as increase in functional ability, fewer disability claims, and less illness caused as side effects of medical treatment or examination. Where treatment ie pain reduction is not possible, the MDT will aim to maximise the patient’s functioning.

Townsend et al describe a case study about a patient Ann who underwent intensive 3 week programme with a MDT to cope with her lower leg pain and end dependency on pain medication. In the case study, the OT’s role in the MDT was to incorporate the various pain control strategies into activities of daily living (ADLs), using for example pacing techniques and appropriate body mechanics. They could possibly have been involved with the functional assessment and assisted with outcome measurement.

Article review: “An On-Site Job Evaluation Performed Via Activity Analysis” by Canelón et al (1997)

Activity analysis is used to evaluate the motor, sensory, cognitive,emotional, behavioural, cultural and social areas of the tasks being carried out in order to complete an activity. In this example, the Biopsychosocial approach is being used to guide the assessment of the patient.

Canelón et al analysed a patient who was experiencing pain in her right wrist following an injury in the workplace and subsequent hand surgery. The patient’s job involved processing insurance paperwork based at a desk workstation, and she was experiencing continued pain despite having an operation and prescribed medication to help with the pain.

I can has RSI?

They carried out an on-site job evaluation and  analysed each motor movement she carried out in great detail at her workplace. They also evaluated her communication style and social interaction with colleagues, concentration and organisation, emotional areas such as her need for gratification, and cultural influences.