Should MD’s do ‘biopsychosocial’ biopsies?
A recent Washington Post article by Michael W. Kahn, began:
“The patient was a college student newly admitted to our inpatient psychiatric unit. Her boyfriend had dumped her by text and then ghosted her. She got tipsy, swallowed a handful of pills and sent several “goodbye” messages on social media. Panicked friends called 911, and campus police picked her up in front of shocked roommates. After a stop in our emergency room, she was admitted to our locked unit. A psychiatry resident (doctor-in-training) whom I was supervising took a thorough history, and then reported back to me about the patient’s symptoms, medical history, physical exam and laboratory findings…”…”“So what was the breakup about?” I asked him. This was an unexpected question. The resident stammered a bit, looked uncomfortable and replied, “I thought that was too personal to ask about…”
The Post article cites a study, published in the American Journal of Medicine, by the same author, which suggest doctors be willing to be invasive in a new way. The author suggests physicians are comfortable with mechanically invasive procedures but are not as well versed in the emotional realm of their patients. He suggests that emotion is a significant component of health, wellbeing and overall health.
Interestingly, most medical doctors are not trained in counseling or therapy and are not as well versed in navigating these areas clinically. I wonder if this kind of training might go a long way in changing the stigma of mental health as well as allow patients and their MD’s to better relate.
This may another example of inclusion bring us closer to a more accurate understanding of the individual. With the integration of physiological and emotional functioning we get a more accurate understanding of the individual. When making a mental health diagnosis we want to rule out any physiological explanations for the presentation before making a mental health diagnosis. Equally, when making a physiologically based diagnosis it is encouraged to consider the patients current emotion and mental health functioning into account.
I really like the steps of the Biopsychosocial biopsy. They involve the doctor asking the patient to “tell me more about it” in 4 areas. This type of open ended exploration can be very powerful and allow greater exploration which tends to relate to greater understanding, albeit a more complex understanding.