PI Brief Update

How Do GPs Treat Psychosocial Problems?

10/01/24. Dr. Mark Burgin BM BCh (oxon) MRCGP explains that GPs take the long view when helping patient with complex psychosocial problems.

Complexity in medicine is less about the number of diagnoses and more about how chaotic the person’s life is which why the Biopsychosocial Model can help complex patients.

When a GP talks about a holistic assessment they really mean that they look at all the person’s life for any area that one of the techniques they have will be effective.

In general the more problems a person has the more likely a GP will be able to find something that they can do to improve the situation.

The process takes time because each problem needs to be assessed, a solution found, the patient needs to try the solution and then make changes to maintain the solution.

Psychological Management of the Psychosocial

Where a patient is making a bad choice there is an opportunity to discuss that choice and help the patient see that a different choice may gives them a better outcome.

Persuading the patient that history is likely to repeat itself and making the same choice will have the same outcome can be as difficult as explaining that a different outcome is better.

If the patient has not caused their situation then the GP’s task is even worse, they have to help the patient to accept their situation so GPs work hard to find a mistake.

Most patients who make mistakes do not have a mental health diagnosis but making mistakes is a major risk factor for mental illness.

Psychodynamic Models

Psychodynamic models are really just stories that explain why a person feels the way that they do and the good ones act as keys to the psychological prison that a person can be in.

The story should make sense and be simple to explain and may even have a catchy title that could be on the front of book such as one about facing fear. (1)

The story takes a pearl of wisdom and shows how it applies to the patient’s experience and gives them a different perspective on the problem.

This explanation of the difficulties that they are facing can allow the patient to make changes and potentially free them from the problem.

Thoughts-Feelings-Behaviour.

Cognitive behavioural therapy is based upon the idea that if the connections between thoughts, feelings and behaviours are examined it can help stress.

The most effective part of this approach has been the identification and breaking down of abnormal thoughts (cognitive) to change behaviours. 

In the biopsychosocial model the GP is more interested in what feelings underlie the thoughts and behaviours looking for patterns that help the GP understand the person.

This rather slower approach can be effective at finding an Insight or an understanding about that person that can help both doctor and patient find solutions.

Conclusions

General practitioners can reduce the chaos in a patient’s life and improve their quality of life as well have clinically important effects on their health.

These changes take months or years to work and are chiefly used to prevent disease so psychosocial work should be started when the patient is still young to have maximum effect.

Identifying bad life choices, showing how pearls of wisdom apply to the individual and finding Insights that apply only to the individual are the techniques that the GP uses.

What appears at first sight to be a distraction from doctors treating patients can achieve results that secondary care cannot come close to, prevention is better than cure.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

1. Susan Jeffers 1987 Feel the Fear And Do It Anyway (Book)

Image ©iStockphoto.com/utah778

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.