A practical assessment of physician biopsychosocial performance

Background: A biopsychosocial approach to care seems to improve patient satisfaction and health outcomes. Nevertheless, this approach is not widely practiced, possibly because its precepts have not been translated into observable skills. Aim: To identify the skill components of a biopsychosocial consultation and develop an tool for their evaluation. Methods: We approached three e-mail discussion groups of family physicians and pooled their responses to the question "what types of observed physician behavior would characterize a biopsychosocial consultation?" We received 35 responses describing 37 types of behavior, all of which seemed to cluster around one of three aspects: patient-centered interview; system-centered and family-centered approach to care; or problem-solving orientation. Using these categories, we developed a nine-item evaluation tool. We used the evaluation tool to score videotaped encounters of patients with two types of doctors: family physicians who were identified by peer ratings to have a highly biopsychosocial orientation (n = 9) or a highly biomedical approach (n = 4); and 44 general practitioners, before and after they had participated in a program that taught a biopsychosocial approach to care.Results: The evaluation tool was found to demonstrate high reliability (α = 0.90) and acceptable interobserver variability. The average scores of the physicians with a highly biopsychosocial orientation were significantly higher than those of physicians with a highly biomedical approach. There were significant differences between the scores of the teaching-program participants before and after the program. Conclusions: A biopsychosocial approach to patient care can be characterized using a valid and easy-to-apply evaluation tool.