Harvard Medical School, and Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Acad Med. 2011 Apr;86(4):509-15. doi: 10.1097/ACM.0b013e31820e0d16.
More than 30 years after its introduction by George Engel, the biopsychosocial model exerts a major influence on the rhetoric and intentions of academic medicine. However, advocates of the model do not feel that it has significantly altered the practice of physicians, whom they portray as tightly clinging to a biomedical approach. Using Engel's original writings, those of his successors, and the work of medical historians, the author asserts that biopsychosocial advocates use clinical biomedicine as a straw man to support their argument. Proceeding from that point, the author attempts to demonstrate that excessive focus on this straw man has inhibited critique of the biopsychosocial model and the argument supporting it. He identifies failures to address clinical medicine's functional specificity and relationship with broader social trends as contributors to the biopsychosocial model's stagnation. The author proposes that it would be more productive to view clinical biomedicine as an epiphenomenon of the human traits of overenthusiasm and the need for security. Recognizing that medicine is made up of heterogeneous tasks, he observes that no one model, including the biopsychosocial model, tends to all of them. The biopsychosocial model would be best served by shedding the biomedical straw man and modifying its ambitions.
自乔治·恩格尔（George Engel）提出以来，生物心理社会模式对学术医学的修辞和意图产生了重大影响。然而，该模式的倡导者并不认为它显著改变了医生的实践，他们将医生描绘为紧紧坚持生物医学方法。作者使用恩格尔的原著、他的后继者的著作和医学史学家的著作，断言生物心理社会模式的倡导者将临床生物医学作为支持其论点的稻草人。由此出发，作者试图证明，对这个稻草人过分关注阻碍了对生物心理社会模式及其支持论点的批判。他认为，未能解决临床医学的功能特异性及其与更广泛社会趋势的关系，是生物心理社会模式停滞不前的原因。作者提出，将临床生物医学视为人类过度热情和对安全的需求这两个特征的副现象，可能会更有成效。他观察到，由于医学由各种不同的任务组成，没有一种模式（包括生物心理社会模式）倾向于涵盖所有这些任务，因此建议摒弃生物医学的稻草人并调整其目标，这将最有利于生物心理社会模式。
