From biomedical to biopsychosocial. Being scientific in the human domain

In an era of managed care that encourages shortened patient encounters, large group practices that limit a consistent primary care physician, and a reliance upon self-report inventories, it is easy to lose the essence of the doctor-patient relationship. Important information seems limited to that which can be entered into a database field. Fortunately, Dr. George L. Engel continues to remind us that it is the dyad of patient and physician that forms the substrate whereby meaningful data can be observed and obtained from a suffering individual. This special article emphasizes the importance of the medical interview not only as a human encounter but also as a rigorous instrument to better understand the patient and help explain the data that the patient presents. Subjective experiences such as sadness, grief, and fear are not soft signs but essential elements of a patient history. Dr. Engel is an internist with psychoanalytic training whose impact upon consultation-liaison psychiatry has been immense. His seminal paper on the biopsychosocial model became an organizing principle for psychiatric education in medical settings. It is the challenge--yet the reward--of the physician to empathically make meaningful connections between the patient's life history and presenting problems to diagnose the difficulties with which the patient presents. This essay demonstrates the rigor involved in such a task.