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Foo20151013 2023 38zku8?1444774057
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The BioPsychoSocial Model of Disease comes to life

The biopsychosocial model of disease existed in my notes... an excuse to get out the colouring crayons and draw a diagram, but ultimately another collection of facts that needed to be digested then regurgitated in the summer exams, something to be fitted in around learning about the important stuff - the science. But the biopsychosocial model has come alive for me recently, now I realise what an impact the later two components, psychological and social, can have on patients. As a former medical student and now full time patient, the model really means something to me now. In the 1977 paper in Science, George Engel introduced the biopsychosocial model: "The dominant model of disease today is biomedical, and it leaves no room within it's framework for the social, psychological and behavioural dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching and a design for action in the real world of health care." Following some conversations on Twitter recently and from my own experience at medical school and now as a patient, I wanted to explore my thoughts on this model. Twitter, in the wonderful way it does, recently introduced me to the Disabled Medic blog, which among many other great posts, has also explored the biopsychosocial model, and I would recommend a read. The biopsychosocial model shows the influence that emotions and social circumstances have on physical health, which is important. But while conversations about the model focus on the way it can be used by healthcare professionals (very important!), it needs emphasising that the model can provide a framework for patients to look at/after themselves. The model highlights the psychological and social causes of disease, but more optimistically, it can show that there are a range of treatments for disease, from the medical to the social and psychological. A diagnosis of a long-term health conditions is often simultaneous with loss of control. There are limitations to the success of medications, treatments and surgeries. And in receiving these, we are relatively passive as patients, no matter how engaged we are. The biopsychosocial model looks at our biological, psychological and social needs, and how these factors influence our overall health. Establishing that these factors affect our health is only the first step. As patients, when psychological and social factors are brought in to the equation, it becomes clear that we ourselves have some power to help ourselves. By framing our health in this more holistic way, as patients we are not as powerless as suggested by the medical model. Through self-management we can make positive changes to our own psychological and social situations, which can in turn benefit our physical biological health. To return to the traditional ground of the model - healthcare professionals.... One strength of the model is that it places psychology side beside its (generally considered) more superior counter-part, biology. I hope that by seeing the biopsychosocial model in action, physicians can appreciate the detrimental psychological impact of a diagnosis, and the assumption of "it is all in the mind" can fall by the way side. By integrating all three elements, the model shows that neither is independent of the others, so it can't be all in the mind, because other factors, biological or social, will be involved to some degree. For me personally, the biopsychosocial model makes me look at what a 'life' is. One of the attractions of medicine is saving lives. Without getting too deeply into philosophy or ethics, I just want to explore for a second what saving a life really means for me, as a patient. I still believe that A&E staff heroically save lives. But I have come to realise that a life is more than a swiggly line on a heart rate monitor. My counsellor has been just as heroic in saving my life, through addressing my emotions. My life is now something I can live, rather than endure. With saving lives being a key (and honourable) motivation among medical staff, it is important that we can allow them to save lives as often as possible, and in many different ways. It may not always be through emergency treatment in resuscitation, but if we embrace the biopsychosical model, they can save lives in many more ways. When there is a limit to the effectiveness of the biological approaches to an ill person, and they can't be returned to the land of the healthy, medical science becomes unstuck. Within the biopsychosocial model, the issue of doctors not being able to do anything is slightly less. As I mentioned in my post about making the transition from medical student to patient, I went to medical school because I wanted to make people better. But I was only being taught one way to make people better - drugs and surgery. If we really embraces the biopsychosocial model, doctors could make a difference, even if their standard tools of drugs aren't available because they could turn to psychological and social support. This isn't to say that all clinicians have to be counsellors or social workers - far from it. But an awareness and appreciation of their contribution to the management of a patient is important, as well as an understanding of the basic principles and skills such as motivational interviewing. In 2013, I don't think I can talk about social in this context without mentioning social media. It was not was Engel originally meant in 1977, but social media has become a vital social tool for patients to manage their health. Ignoring anxieties and postural problems associated with sitting at a screen seeing everyone else's photo-shopped lives, it is undeniable that social media is a big and good resource that can empower patients to take responsibility and manage their own health. To see the best examples in action, take a look at Michael Seres and his blog, Being a Patient Isn't Easy to see a whole new meaning to the social in biopsychosocial! I am still very grateful for the biological expertise of my medical team. Don't get me wrong - it's a good place to start and I wouldn't be here writing this post today if it wasn't for the biological support. But with chronic illness, when you are past the dramatic relapses, the biological isn't enough.... The biology has allowed me to live, but its the psychological and social support I have received that has allowed me to live. Anya de Iongh @anyadei www.thepatientpatient2011.blogspot.co.uk  
Anya de Iongh
over 8 years ago
0
0
70

Which drugs are banned by the IOC?

What are drugs banned by international olympic commitee ?  
sampath kumar
over 8 years ago
Preview
3
201

Peri-arrest Arrhythmias

A resource made to accompany an RLO on peri-arrest arrhythmias I designed as part of my Doctors as Teachers project at Peninsula. It describes the assessment and management of peri-arrest arrhythmias as well as pharmacology of certain drugs used in their management. Hope you find it useful x  
Hope Raybould
over 8 years ago
6
0
22

Can someone help me with a question on epilepsy treatment?

Understanding the neurophysiology is important in treating epilepsy. In practice, how far often is it properly evaluated and how often is it simply treated by the drugs alone without any proper evaluation? Is the EEG a specific tool in epilepsy screening?  
sampath kumar
almost 9 years ago
3
0
34

New treatment protocol for Hepatitis C?

Does anyone know the new anti viral drugs in trial for hepatitis C treatment?  
sampath kumar
almost 9 years ago
13
0
14

What are the adverse effects of using central venous drugs in peripheral veins?

I've seen them used in peripheral veins. What about the long-term consequences?  
Rama Raja
almost 9 years ago
Foo20151013 2023 184etvn?1444773944
3
135

Aspergillus and Human Health

Many may be familiar with aspergillosis as the infecting agent in acute cases where the patient is severely immunocompromised - but there is more to this fungus' repertoire. There are rare cases where the patient's immune system is overwhelmed by a large inhalation of spores e.g. after gardening, but these are insignificant in terms of total numbers effected. The following are far more common:- Aspergillus and other fungi are increasingly identified as the active agent in sinusitis - if you have cases that don't respond to antibiotics this is worth thinking about. Chronic pulmonary aspergillosis (CPA & aspergilloma) is an infection of immunocompetent people, causing respiratory difficulty, coughing and haemoptysis. The UK NHS has a specialist centre for these patients In Manchester (National Aspergillosis Centre (NAC)). NAC has particular expertise and extensive facilities for the diagnosis of CPA, ABPA, SAFS and use of systemic antifungal drugs. Allergic infection (Allergic Bronchopulmonary Aspergillosis - ABPA and chronic sinusitis) is thought to be heavily underdiagnosed and undertreated. ABPA is particularly common in Asthma, Cystic Fibrosis patients and those with bronchiectasis. There is estimated to be 25 000 cases in the UK alone. Many (50%) of the most severe asthma cases are sensitive to fungi (SAFS) - in particular Aspergillus. These tend to be the most unstable cases that don't respond to antibiotics and several studies have been published that show giving an antifungal helps reduce the use of steroids for these patients. Last but not least - Tuberculosis is on the rise in the UK and the rest of the world. It is estimated that 2% of cases progress to CPA and should be treated using an antifungal - this is usually not done until considerable time has passed and much damage has been done. In total it is estimated that many millions of people across the world suffer from aspergillus - ABPA - 5 million, Tb - 400 000 per year and Asthma (SAFS - 1 - 4 million cases in EU & US). Sinusitis cases may number many tens of millions worldwide. So - the next time you assume aspergillus infections and aspergillosis are rare and confined to those who are profoundly immunocompromised - think again! If you have a patient who has increasingly severe respiratory symptoms, doesn't respond to multiple courses of antibiotics then give aspergillus a thought. Browse around these articles for further information Aspergillus Website Treatment Section. NB For a broader look at the prevalence of fungal diseases worldwide the new charity Leading International Fungal Education (LIFE) website is worth looking at.  
Graham Atherton
almost 9 years ago
10
0
23

What is the best & safest anti-thyroid drugs to be administered during pregnancy

I went through some websites and books, and they pretty much contradict each other. Some says PTU, and the other sources recommend carbimazoles. I'll be very happy to hear answers from anyone who can solve my confusion.  
sukri nawi
almost 9 years ago
13
0
14

What is the future of organ transplants?

Give the death this week of Dr Joseph Murray, who won the Nobel Prize for performing the first-ever successful organ transplant (a renal transplant), I was wander what the future of this area is? Does anyone know what likely advances are going to be made to stop the risk of rejection while minimising the risk of anti-rejection drugs to the patient?  
Jon Michael
about 9 years ago
9
0
25

Cytotoxic Drugs

Hey guys, I'm really struggling with this. I've read that alkylating agents - a particular type of cytotoxic drug - work through the pairing of alkylguanine and thymine, which leads to the substitution of AT for GC and therefore defective replication. I'm confused as to why this automatically leads to this substitution?  
Gemma Loach
about 9 years ago
6
0
86

What drugs might induce nervous breakdown?

What drugs might induce nervous breakdown?  
komal zafar
over 9 years ago
30081o
2
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Liver pathology 2

Audio podcast outlining the pathological processes that occur in the liver including; infection, alcohol abuse, drugs toxicity, metabolic abnormalities, autoimmune processes and neoplasia.  
Podmedics
over 10 years ago
Preview
11
238

Drugs: From Molecules to Man

Revision notes from First Year at The University of Manchester Faculty of Life Sciences. There may be blocks of text copied from such books as Rang and Dale, if there are any issues with copyright or plagiarism please inform me and I'll remove this resource immediately.  
Daniel Sapier
over 10 years ago
Preview
43
3723

Phamacological Revision Guide: Management of Essential Hypertension

An interactive powerpoint about drugs used to treat hypertension. It is aimed at medical students, mainly those in their first clinical year.  
Manuella Mount
almost 11 years ago
Preview
8
543

Muscle relaxant drugs

Overview of muscle relaxant drugs used during anaesthesia.  
Nigel Harper
almost 11 years ago
Twitter50text
1
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Getting antifungal levels right - why does it matter? by David Andes

Antifungal drugs (e.g. Itraconazole, Voriconazole and Posaconazole) have a variable and unpredictable dose–concentration relationship, and therefore need careful concentration management. Problems may occur whether the concentration is either too low or too high, and it is difficult to maintain a concentration that falls within the therapeutic window.  
Aspergillus Website
over 11 years ago
13
1
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Why is invasive aspergillosis such a difficult disease to diagnose and treat? by Marta Stanzani

Dr Stanzani explains that fungal cells are very similar to human cells, and that drugs which are toxic to fungals cells may have the same effect on human cells. Mortality in invasive aspergillosis depends largely on the timing of the intervention, timely diagnosis and the state of the patient’s defences – treatment is much more effective when people have an intact immune system.  
Aspergillus Website
over 11 years ago