BEHAVIORAL SCIENCES – DR.

SANA
ARIF Lecture 2 & 3
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REVIEW OF LAST LECTURE
Introduction to Behavioral sciences
Traditional versus holistic medicine
Four Elements of Holistic Medicines
Define Behavioral sciences
Psychology
Sociology
Anthropology
LECTURE 1 2
LECTURE OUTLINE
Bio-Psycho-social (BPS) model of Health Care
Use of Non-Pharmacological Interventions in Clinical Practice:
Communication Skills

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 BIO-PSYCHO-SOCIAL
MODEL(BPS)
“A conceptual model that assumes that psychological
(mood, personality, behavior, etc.), and social factors
(cultural, familial, socioeconomic, medical, etc.) must also
be included along with the biologic (genetic,
biochemical, etc)in understanding a person's medical
illness or disorder.”

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George Engel in 1977 for the 1st time started to
emphasis the importance of integrating traditional
biological aspects of medicine i.e.
pathophysiological and structural with behavioral
sciences i.e. psychology, sociology, anthropology
and put forward the concept of Bio-Psycho-Social
perspective of health and disease.

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Engel’s model was based on 3 principles:
1. Disease is a result of multiple factors that interact to
make an individual feel ill. Illness and disease are not a
consequence of biological factor alone.
2. An individual is composed of a complex, integrated
system of interacting subsystem elements of mind, body,
spirit, and social relationships. Any change in one will
result in change in other systems too.
3. Biological, psychological and social factors form a triad
to interact and serve as determinants of disease.
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The biological system ensures a structural, biochemical
and a molecular study of disease;
The psychological system provides an insight into the
role of personality, attributes, other dynamic factors and
motivation in genesis of the illness.

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Social system emphasizes the impact of family, society,
social forces, culture on the etiology, presentation and
management of the given illness.
BPS model stresses on the understanding and
manipulation of psychosocial environment of a patient
recovery in a same way as the study of
pathophysiological process and methods of treatment is
used to reverse disease.

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 CLINICAL APPLICATION OF BPS
MODEL
✔ Provides a comprehensive clinical approach towards the practice
of holistic medicine.
✔ This approach lays a great emphasis on Doctor-patient relationship
which involves Psychosocial assessment.
The use of communication skills
Informational care
Counseling
crisis intervention
Extension of care to the family
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 CONT….
✔ Research shows that biomedical and behavioral
factors come into play in infectious as well as non
infectious disorders.
✔ It assigns the emphasis to the use of interventions
that do not involve surgery or drugs: The Non
Pharmacological intervention(NPIs)

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 NON PHARMACOLOGICAL
INTERVENTIONS (NPIS) IN CLINICAL
PRACTICE
Use of these interventions is advocated in BPS
model for
Enhancing and augmenting the impact of physical methods
of treatment i.e. the drug and surgical treatment
Enhancing patient satisfaction
Improves adherence to the treatment
Strengthen the bond between doctor, patient and
community
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NPIs used for diagnostic and therapeutic
advantage includes:
1. Communication skills
2. Counselling
3. Informational care
4. Handling difficult patients and their families
5. Breaking bad news
6. Conflict resolution
7. Disaster management

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 1.COMMUNICATION SKILLS
Communication is sending and receiving information
between two or more people. The person sending the
message is referred to as the sender, while the person
receiving the information is called the receiver.

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 TYPES OF COMMUNICATION
Communication is an important component in the health
care field. Employees in hospitals, nursing homes and
other medical settings need to communicate regularly with
patients and residents about medical procedures, daily
care tasks and the patient’s overall health.
1. Verbal Vs. Non Verbal Communication
2. Formal Vs. Non formal Communication
3. Technology aided communication
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 COMMUNICATION SKILLS
An effective communication is a vital tool in clinical
settings as it forms the basis of interaction between
doctor and the patient.
Problem:
Arises when the two parties find it difficult to
communicate or understand each other
Doctor should know patient’s language
Doctor should not use medical terms
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Tools for effective communication

I. Attending and listening

II. Active listening
III. Verbal techniques

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I) ATTENDING AND LISTENING
Attending is the act of truly focusing on the
patient and involves a conscious effort on the part
of a doctor to keep himself aware of what the
other person is saying and trying to imply.
This can only be done in setting of exclusivity.
(Restriction to a particular person)

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Signs of in-exclusivity:
Standing on the bedside of the patient
Standing with fellow student
Amidst(among) the traffic in the ward
Attending mobile calls simultaneously
Eating or drinking while talking to the patient

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II) ACTIVE LISTENING
It is a process that goes beyond
merely hearing and making notes of what patient
says.
It involves a simultaneous focus on linguistic and
paralinguistic features of speech.

Linguistic aspect includes words and verbal aspect

of speech.
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Where as Paralinguistic aspect includes non
verbal features of speech such as

Timing
Volume
Pitch
Accent
Fluency
Pauses
umms and errs

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Body Language of a patient refers to the way a
patient expresses himself through the use of non verbal
cues such as:
Facial expressions
Proximity to the doctor
Use of gestures
Body position
Movements
Eye contact
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III) VERBAL TECHNIQUES
These are pivotal in making communication
effective and thus contribute towards therapeutic
process.
These are vital skills for the doctors and learnt with
practice.

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Verbal communication involves 6 components:
1. Questions
2. Funneling
3. Paraphrasing
4. Selective reflection
5. Empathy building
6. Checking for understanding

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QUESTIONS:
Open ended question
Close ended question
Leading questions

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CLOSE ENDED QUESTIONS
Elicit fixed response…. yes or no answer
e.g.
Are you married?
Do you feel nausea after taking meals?

These questions are vital to start interaction.

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OPEN ENDED QUESTION
They do not elicit particular answer. e.g. What brings
you to the hospital today?
They are intended to encourage patients to talk more
about their stories.
These are asked for exploration of a particular aspect
For obtaining further information
To clarify any details
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 LEADING QUESTIONS
They prompt the patient to answer in a certain way.
They Should be avoided
e.g.
Don’t you think your pain radiates into left arm?
Do you feel ashamed of short stature?
Why questions should be avoided
e.g.
Why do you think you have developed shortness of breath?

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FUNNELING
This technique refers to the use of questions to guide the
conversation from broader area to a specific area.
This technique helps the interviewer to make the
communication move from general aspect to the specific.
e.g.
Now that you have described the feeling of pain, can
you refer the area of pain?
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PARAPHRASING
Paraphrased material is usually shorter than the original passage, taking a
somewhat broader segment of the source and condensing it slightly.

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SELECTIVE REFLECTION
It is a technique to bring out the feelings attached
to various symptoms and problems that a patient
has stated.E.g.

How does it feel when you start to feel fatigued only

waking for a few minutes?
You told me earlier, that you were once athlete who could
easily run a mile.
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 EMPATHY BUILDING
“The capacity to place oneself in another's position”
It refers to the statement by the doctor that makes the patient
understand that his or her feelings have been well understood.
The doctor would have felt the same if he or she was in
patient’s place.
Avoid expressing sympathy that would imply doctor feels bad
about the patient e.g.
Poor you! I really feel bad on hearing your story.
I can imagine how difficult it must be for you to live with your pain for such a long time.

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FACTORS THAT IMPROVE
COMMUNICATION
Use of minimal prompts
Sit squarely in relation to the patient
Open body position in relation to the patient
Lean slightly towards the client
Eye contact reasonably maintained
Relaxed and attentive
Listen & respond to feelings
Note all paralinguistic and non verbal cues

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FACTORS THAT OBSTRUCT
COMMUNICATION
Lack of exclusivity
A preoccupied or anxious doctor
Awkward and uncomfortable seating
Lack of attention to non verbal cues during active listening
Offensive remarks/judgment by doctor
Frequent interruptions
Selective listening
Day dreaming or dozing off during communication
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