Beliefs that foster physician avoidance of psychosocial aspects of health care.

Although training in family medicine emphasizes a biopsychosocial approach to patients, many residents experience difficulties in carrying out the appropriate psychosocial part of their diagnosis and treatment. Through teaching family medicine residents in a year-long Balint and Difficult Patient seminar, there has emerged a consistent set of core tacit beliefs which inhibit physicians from thinking psychosocially about their patients. These beliefs appear to be rigidly held but not examined or challenged. This paper presents the major of these beliefs and for each a more realistic therapeutic reply. They are grouped into three categories: (1) beliefs concerning physician's role (eg, I must rule out organic disease; only then can I focus on psychosocial problems), (2) beliefs concerning what the patient supposedly wants or does not want (eg, my patients want me to rule out organic problems), and (3) physicians" fears about approaching patients as people (eg, if the patient has the same problem I do, how can I help if I have not helped myself). By making overt these tacit assumptions, this paper attempts to highlight core barriers to the implementation of biopsychosocial care, increase understanding of effective alternatives, and challenge physicians to examine their hidden beliefs about patient care and their approach to patients.