MGH Division of Psychiatry and Medicine, Boston, MA 02114, USA.
Psychosomatics. 2010 Sep-Oct;51(5):365-9. doi: 10.1176/appi.psy.51.5.365.
The commonly-accepted "biopsychosocial model" does not always lend itself to the kind of pragmatic decisions that many clinical situations demand of physicians.
The authors attempt to identify and close gaps in the biopsychosocial model that hinder its application in certain real-life clinical situations.
The authors review some of the current and historical literature on the development and application of the biopsychosocial model, and argue the shortcomings of this modality in various clinical situations.
The authors present three dicta to guide clinicians toward relevant areas of inquiry: 1) Think neuroanatomically; 2) Think existentially; and 3) Think "dirty;" that is, understand that patients and physicians sometimes work toward different goals.
These dicta form an addendum to the biopsychosocial model, identifying and filling three specific, commonly-encountered gaps in that paradigm, which, ironically, is usually considered all-inclusive.
普遍接受的“生物心理社会模式”并不总是适用于许多临床情况所要求的那种务实决策。
作者试图找出并弥合生物心理社会模式中的差距，这些差距阻碍了它在某些现实临床情况下的应用。
作者回顾了一些关于生物心理社会模式的发展和应用的当前和历史文献，并论证了这种模式在各种临床情况下的缺点。
作者提出了三个原则来指导临床医生进行相关的探究：1）从神经解剖学角度思考；2）从存在主义角度思考；3）从“肮脏”的角度思考，也就是说，要明白患者和医生有时会朝着不同的目标努力。
这些原则构成了生物心理社会模式的附录，确定并填补了该范式中三个常见的具体差距，而具有讽刺意味的是，该范式通常被认为是包罗万象的。
