One of the interesting aspects of the recent physiotherapy discussions on social media about the benefits of the biopsychosocial model is the almost complete lack of the ‘social’.
Those who advocate for the model seem comfortable with the idea that physiotherapy might be ready to embrace its psychological dimensions – although, often, the ‘psychological’ is lazily referred to as a singular entity – but little is said about the social dimensions of physiotherapy.
Perhaps physiotherapists are not aware of the full scale of the social dimensions of practice? Many practitioners, for instance, still ignore the fact that the social determinants of health (poverty, education level, access to services, poor living conditions, for example), are far more important than personal responsibility or behaviour in determining the incident, prevalence and burden of illness (see readings below).
This point was made this week by Dawn Skelton, professor of ageing and health at Glasgow Caledonian University and an honorary member of the CSP, in a piece that argue that the care of the frail elderly needs as much care and attention as drug prescriptions.
If we can accept the argument that the future of physiotherapy is likely to involve us working with the more complex clients, many of whom will have multiple physical, psychological and social co-morbidities, then it follows that a lot more of our work will be with the elderly, with people in chronic pain or breathlessness, and people for whom a more holistic approach to practice is vital.
I made this argument at a keynote lecture I gave recently at the Australian Physiotherapy Conference, arguing that a central feature of any successful elderly care practice is social. A recent paper in the journal Health illustrates this point. (Note here how different the language is from ‘typical’ physiotherapy papers – evidence perhaps of the work we now need to do to get up to speed with sociological thinking.)
There are some excellent journals and research sources where physiotherapists can up-skill in their knowledge and understanding of sociology. Try Social Science & Medicine, Sociology of Health & Illness, Body & Society or Health, the journal mentioned above, for example.
All of these offer material that is directly relevant to future physiotherapy practice. All that’s needed now is a little more sociological imagination.
Readings
Baum, F. (2016). The New Public Health. Oxford: OUP.
Keleher, H., & MacDougall, C. (2011). Understanding health: A determinants approach. Australia: Oxford University Press.
Marmot, M. (2001). Economic and social determinants of disease. Bulletin of the World Health Organization, 79(10), 988-989.
Marmot, M., Friel, S., Bell, R., Houweling, T. A., & Taylor, S. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650), 1661-1669.
Dave, I agree with you in that the social part of the BPS healthcare model is often ignored in research, but from a clinician’s point of view we can do the most to influence the ‘psycho’ part of the extended problem?
Anyhow, when you form a therapeutic relationship with your patient with good clinical communication – you will pick both these up and address within your ability?
Hi Ina,
I would agree, but only to a point. Your argument suggests that the social can be subsumed under the bio- and psycho-: that it will come in alongside forming a good therapeutic relationship with the client. I think there are some issues with this. The ‘social’ that I’m talking about could be considered a separate ‘third’ paradigm that physiotherapists have yet to engage with very much. It includes much of what is studied by sociology, and is quite distinct from biomedical and psychological ways of thinking. So if it does sneak in alongside the others, it is probably a misunderstood or, at best, anaemic version of what is otherwise a very powerful set of ideas. At the same time, having a good appreciation for the social might significantly strengthen our relationship with our clients, and that might also bring some of the bio- and psycho- along with it. It would be interesting to see how others feel about this.