So this week’s been fun. First tweet seen the other day was a link to CPN’s Dave Nicholls’ blog about the Biopsychosocial (BPS) model. As ever, Dave provided a short, focused, erudite commentary on the use and possible limitations of a currently favoured healthcare model. This adds to and reflects a large literature on the subject and provokes thought towards where we might go from here. One day. Perhaps. I thought it was quite nice.
However, all was not straight forward. A quick retweet ended up with a barrage of seemingly anti-critique-of-the-BPS-model come-backs. All in good spirit, I’m sure. But I do think a couple of things have arisen from this Twitter dialogue. Let me summarise the main themes of the responses. I think one issue is the direct critique of the model. Seems folks don’t like this. The second is the place of philosophical discussion within medicine and healthcare. Seems folks don’t like this either. What struck me most was that many comments were being fired from folks who I consider to be among the most progressive and critical thinking practitioners I know (and I love them all the more following these recent exchanges). For me though, this meant some personal reflection on my position. Was I missing something? So I’ve been pondering on the discussions and here’s what I think.
First, the reaction to critique of the BPS model. Here are a couple of responses as examples:
Now I do get that we might want solutions and not just challenges. But typically solutions come after something solvable is exposed, which is usually done by challenging an issue. It would be unusual to have a solution to a problem which hasn’t yet been identified. So to expect answers to these sorts of (valid) questions is too some degree overly ambitious. The development of the BPS model came a long way after exposing the limitations of the biomedical model, and it was only through realising these limitations that thought towards solutions could be presented. There is also a suggestion here that we have some sort of complete understanding of the human condition and we are at the end of our scientific journey. This is sort of missing the point of science. So I do apologise King Tom and Queen Jack, but can I get back to you when science and critical analysis, as per the history of forever, have had a bit more time please? Thanks. Smiley face.
The next concern was about over-philosophising in medicine and the health sciences. Here’s an excellent quip from Sir Jason of America along these lines:
. . . aaaaand again:
Guys, once again, I see your point. We are practical people, we want practical answers. We don’t want to waste our precious time – nor that of the humans we work with (see how I didn’t say ‘patients’) – trying to plough through unpenetratable theory, especially if the practical relevance isn’t obvious.
And that’s the point.
With abstract critical analysis and complex thinking, the relevance often isn’t obvious. That doesn’t mean there is no practical relevance though. The relevance may come with time and further analysis. Who would have thought that in 1748 some abstract philosophy on regularly occurring events and counterfactuals would lead to the undertaking of the first medical randomised controlled trial some 204 years and tomes of abstract philosophy on the same subject later? Who would have gambled on abstract thought on complex and imaginary numbers in the 16th century would provide the key to developing alternating current just a short 200 years later? There is an extreme sociopolitical worry when movements are made to police thought in general. But in science and technology in particular, the consequences of curtailing thought based on ‘I can’t see any immediate practical application’ could be dire for the progress of the world, and in our case global health.
It’s totally fine to have a favoured model. But it won’t last forever. Nowt ever does. Except for hair gel. Hair gel lasts forever.