A practical assessment of physician biopsychosocial performance

Abstract

Background: A biopsychosocial approach to care seems to improve patient satisfaction and health outcomes. Nevertheless, this approach is not widely practiced, possibly because its precepts have not been translated into observable skills.

Aim: To identify the skill components of a biopsychosocial consultation and develop an tool for their evaluation.

Methods: We approached three e-mail discussion groups of family physicians and pooled their responses to the question “what types of observed physician behavior would characterize a biopsychosocial consultation?” We received 35 responses describing 37 types of behavior, all of which seemed to cluster around one of three aspects: patient-centered interview; system-centered and family-centered approach to care; or problem-solving orientation. Using these categories, we developed a nine-item evaluation tool. We used the evaluation tool to score videotaped encounters of patients with two types of doctors: family physicians who were identified by peer ratings to have a highly biopsychosocial orientation (n = 9) or a highly biomedical approach (n = 4); and 44 general practitioners, before and after they had participated in a program that taught a biopsychosocial approach to care.

Results: The evaluation tool was found to demonstrate high reliability (α = 0.90) and acceptable interobserver variability. The average scores of the physicians with a highly biopsychosocial orientation were significantly higher than those of physicians with a highly biomedical approach. There were significant differences between the scores of the teaching-program participants before and after the program.

Conclusions: A biopsychosocial approach to patient care can be characterized using a valid and easy-to-apply evaluation tool.

Additional information

Notes on contributors

Alon Pa Margalit

DR MARGALIT is a board-certified family physician and Director of a biopsychosocial clinic for unexplained medical symptoms patients. He is the Chief Surgeon of School Health in Israel. He served as a Coordinator of Education, Family Health Care Department in Haifa and has coordinated and taught continuing education programs in Primary Care and Family Medicine at the University of Tel-Aviv, Ben-Gurion University and the Medical Corps of the Israeli army.

Shimon M. Glick

DR GLICK is an internist, endocrinologist and professor emeritus at Ben Gurion University of the Negev, where he formerly served as Dean and as head of the Moshe Prywes Centre of Medical Education. He currently serves as ombudsman for Israel's National Health Service.

Jochanan Benbassat

DR BENBASSAT is an internist and a Research Associate at the Myers-JDC-Brookdale Institute. Formerly, he was a Professor of Medicine and the Israel Wechsler Professor of Medical Education at the Hebrew-University Hadassah Medical School, and Head of the Department of Sociology of Health at the Ben Gurion university.

Ayala Cohen

DR AYALA COHEN is a member on the Faculty of Industrial Engineering and Management at the Technion-Israel Institute of Technology. She is Professor and Head of the Statistics Laboratory that operates within the Technion Research and Development Foundation. Her main research areas are Biostatistics and Statistical methods in the Behavioral Sciences.

Carmi Z. Margolis

DR MARGOLIS, is a pediatrist, Director of the Moshe Prywes Center for Medical Education and Co-Director of the BGU – M.D. Program in International Health and Medicine in collaboration with Columbia University Health Sciences. Professor emeritus at Ben Gurion University of the Negev. He was Head of the pediatric department.