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

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.

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”