At a large NSW teaching hospital, a renal advanced trainee is attempting a renal biopsy of 54 year old male. The patient is already agitated and repeatedly asks the doctor if it is going to hurt. The trainee picks up the large needle that he will use and shows it to the patient, “see, this is the gun I am using. You shouldn’t be afraid.”
One of the qualities of effective communication is to use a biopsychosocial approach to medicine. Because some physicians have not been taught how to use empathy in their training as medical students and residents, they may be ineffective in the care of patients¹.
The biopsychosocial approach
The case above highlights the importance of recognising the feelings. Healthcare professionals offer patient-centred medicine with an altruistic focus on both patient cure and care. We are taught that the treatment of a patient’s illness, together with their psychosocial issues, have a vital influence on patient outcomes. This biopsychosocial approach incorporates the complementary clinical approach to medicine with the psychosocial knowledge, skills, and attitude.
Psychosocial medicine is acutely important in practise when faced with medico-legal complaints, patient dissatisfaction, and non compliance to treatment options.
A seminal study published in 1969² determined that psychosocial reactions to disease fall into four classes:
- The personality of the patient and their life history
- the state of the patient’s current interpersonal relationships
- characteristics of his non-human environment, and
- the nature of the pathological process or injury
Over time and in practise variables such as time, communication skills, and patient awareness has shifted the focus away from these four classes.
We need to bring back this approach and realise the importance of not only treating the disease, but the value of treating the patient.