Professor Edzard Ernst discovers the biopsychosocial model of health care 40 years after George Engle.

January 26, 2011
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The latest news from Professor Ernst in his Pulse column is hardly new, just more anecdotes being regurgitated for his ill-informed disciples as new.  The “political correctness” Ernst is referring to came out of the recommendations of the Bristol Inquiry  in 2001 where a lance was put through the paternalist “doctor knows best approach to health care”. The Kingst Fund published their report on the inadequate way doctors communicate with patients back in 1998

Professor Ernst recently attended a conference, where he changed his mind about giving patients a say in their health care: Ernst discovered that:

Patients want a meaningful dialogue with their healthcare team. Good communication within that team is crucially important, they believe. On the part of the doctor, this includes listening to patients and having time to do so. It also means understanding patients’ worries and the fact that information needs to be repeated.

If all this is new to the professor and his evidence is only anecdotal from the three patients speaking at the conference, he should spend more time observing patient interactions at the Anglo European College of Chiropractic. They have been teaching the model since Gordon Wadell adapted George Engels Biopsychosocial model for back pain for the BMJ in the 90s. (Wadell is an advocate for chiropractic and osteopathy so perhaps his opinion is not valued in skeptic world. The College of Chiropractors have also been promoting the implementation of the Bio Psychosocial model for the management of pain syndromes to the chiropractic profession for almost ten years now. I even touched on it in this blog last April.

Below is Professor Ernst latest discovery:

For medical conferences, it has become fashionable (and politically correct) to ask patients to present their views. In CAM meetings, this usually entails a patient telling the audience how marvellous her (it usually is a woman) Reiki healer, aromatherapist etc, has been compared to her ghastly experience with mainstream medicine. These lectures are usually loaded with emotion and devoid of anything remotely resembling data, evidence or rational thought. Suffice to say, I find most of them cringingly embarrassing and utterly unhelpful.

Recently, however, I attended a session entitled ‘What Patients Want’ which was scheduled during a large rheumatology meeting. It somewhat changed my mind. There were not one but three patients presenting in succession. All were suffering from chronic rheumatic conditions and all were remarkably rational. Here are some of the recurring themes voiced by them.

Click here to find out more!Patients want to stay in work and often worry that their condition might prevent them doing so. They are concerned that pain, fatigue, lack of mobility, disability will force them to quit their job. This has more than just financial implications; it importantly impinges on their quality of life and their physical as well as emotional well-being.

Patients also want an early and correct diagnosis so that they can receive the best treatments for their disease. Treating long-term conditions early on, they feel, increases the chances to keep them ‘low key’. Even if that should not be possible, early diagnosis would reduce patients’ suffering. This also means patients want reliable information and easy access to effective therapy.

Patients want a meaningful dialogue with their healthcare team. Good communication within that team is crucially important, they believe. On the part of the doctor, this includes listening to patients and having time to do so. It also means understanding patients’ worries and the fact that information needs to be repeated. What is obvious to us healthcare professionals is often entirely new to patients. To make matters worse, patients are frequently too nervous to take it all in the first time. So repetition is necessary. Finally, a good therapeutic relationship has to give hope and must help patients to cope with their condition.

None of the three patient presenters said ‘we want access to alternative practitioners’. But, it was clear that patients often don’t get what they want from their GP – and this is when they go off and seek it elsewhere, e.g. from CAM practitioners.

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter

What is clear patients want practitioners who know their stuff and are experienced. A person with spinal joint dysfunction/subluxation producing a pain syndrome who should they go to: A GP? an academic who reads all the journals or someone experienced in restoring spinal joint motion/ correcting subluxations?

I will debate any chiropractic skeptic “expert” with medical training. Because if they are skeptical about spinal joint dysfunction Ernst, Singh et al, they dont know their basic anatomy and physiology which is far more relevant to individuals and their care than whats in  “scientific journals”  

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  1. Wellness and the Biopsychosocial Model of health care.
  2. Just goes to show how little Professor Edzard Ernst knows about chiropractic
  3. GCC Fiddles While Edzard Ernst Burns
  4. Edzard Ernst Presents his views to the GCC
  5. These are my comments on the article professor Edzard Ernst had published in the New Scientist last summer about chiropractic.
  6. Check out sceptics blogs, they are getting very emotional about the fall of their great leader.
  7. Ezard Ernst is blaming Prince Charles for costing him his job? Seems Ernst can dish it out, but not so good at taking it.
  8. Vacancy for a former medical doctor who did a bit of Woo on the side.
  9. How can Edzart Ernst be considered an expert on clinical Chiropractic?
  10. Despite the damage done by the BCA the chiropractic profession should not seek “legitimacy” through the biomedical model

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  • http://www.chiropracticlive.com Richard Lanigan

    They must believe we are complete idiots. Ernst says he did not say it, so they all take it as gospel without even reading what he wrote. If this was a football match we would be chanting “your not singing any more”.

    The fact is Ezard Ernst was a CAM practitioner in Austria who “could not do”, so he started teaching. He found a niche area in the UK where there were no other CAM professors who would challenged him (only other CAM academics who “could not do”). He has got away with his lack of knowledge by spinning evidence and making outlandish statements to the press, championed by a media savvy band of skeptic disciples who put him up on a pedestal. The nations health editors bought into it in the same way the showbiz editors have bought into Jordan; big and loud.

    We have seen the best Ernst and the sceptics have to offer, chiropractic is not homeopathy. Yes there is a lack of “evidence” supporting the relationship between spinal joint dysfunction/subluxation and wellbeing, but there is a strong anatomical and physiological science supporting subluxation theory. Rather than trying to shout louder than the bigots we need to work much harder at how we articulate the benefits of chiropractic care.

  • Guthrie Steer

    @ EE

    “it is hard to imagine a more misleading interprtation of what i wrote”

    It’s equally hard to imagine that post being written by someone who more consistently presents a misleading interpretation of what I do.

  • Fedup

    I totally agrre with Richard, what patients want is a clear understanding of their problem and an effective treatment, not time and a few nice words. Is a GP classed as effectice if he spends more time talking and listening or writing prescriptions? For the majority of musculo-skeletal problems going to see you GP is classed as a waste of time, or so my patients tell me. Would you go and see your GP for toothache? Why not? It’s because you want to see a specialist in that area ie a dentist. No different to low back or neck problems IMO.

  • Stefaan Vossen

    I also missed this gem:
    “Recently, however, I attended a session entitled ‘What Patients Want’ which was scheduled during a large rheumatology meeting. It somewhat changed my mind.”
    I don’t know how anyone is supposed to reinterpret that other then that you “recently changed your mind”?
    Which is really what Richard is commenting on isn’t it?
    Stefaan

  • Stefaan Vossen

    It is not hard at all Edzard, most of your titles don’t match the verifiable content of what you write, so quite frankly: if what you say is that you didn’t “recently dicover” then your editiorial rights must be questioned and if it is what you’re saying, … well then Richard is right. Either way it’s not looking too clever is it?
    Stefaan
    This is only the beginning

  • http://www.chiropracticlive.com Richard Lanigan

    Its admirable the way CAM sceptics bringing the wagons round to defend their spiritual leader in their efforts to marginalise CAM.

    The sycophantic Blue Wode and Zeno dont even get it. They Tweet that my “post is inaccurate, the mighty one told you it’s not new to him”

    I am reminded of the saying “the lights are on, but nobody is home”.

    In your reply you state “it is hard to imagine a more misleading interpretation of what Iwrote”. Well you would say that wouldnd you. We all know what a fertile imagination you have when it comes to reporting studies on chiropractic. In this instance the facts speak for themselves.

    I commented on the article yesterday evening pointing out that this was not new to chiropractors and was being taught at AECC for many years. Your response which I have only just seen is. “Nothing new, you are right. But did i state that any of this is new? I just think that it is worth being reminded of. Anyway, if i have something NEW, I’d try the lancet rather than this blog”.

    Claiming you knew it all along, when the article is titled and promoted on the Pulse website as something you “discovered”; to be precise the article is titled; “At a medical conference, Edzard Ernst discovers what patients really want”.

    Not to forget your Column in Pulse is titled “Hear the latest view from Edzard Ernst”. Was this article an exception to the rule and should have been titled Hear Ezard Ernst’s latest view, GPs need reminding of the way chiropractors communicate with their patients, because patients would rather be seen by a GP who treats them like a chiropractor.

    “Misleading”? As soon as I read the article in pulse, my first thought was the “only professor of complementry of medicine” does not know a lot about chiropractic, I included your article word for word in my post so people can draw their own conclusions from what you said.

    I would ask you to point out how my interpretation is misleading and if you meant to say something else what is it you wanted to say.

    As far as I can see you have “discovered what patients want from their GPs” and I am telling you I and many chiropractors have been offering that service since we graduated from AECC. In that I agree patients want knowledgeable practitioners with good communication skills. You read journals and write for newspapers for a living, I help people return to normal activity and stay there.

    You presume to be knowledgeable about what I do (chiropractic), when in fact you have never met me been in my clinic and you know nothing about the way I communicate with patients or what I do. The extraordinary thing is you guys dont even realise how little you know.

  • Pingback: Tweets that mention Professor Edzard Ernst discovers the biopsychosocial model of health care 40 years after George Engle. -- Topsy.com

  • Edzard Ernst

    it is hard to imagine a more misleading interprtation of what i wrote

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