Viewpoint: Physicians should add 'biopsychosocial biopsies' to patient visits

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Physicians should start doing biopsychosocial biopsies: a different kind of invasive procedure that doesn't involve needles or samples of bodily tissues, according to Michael Kahn, MD, psychiatrist at Boston-based Harvard Medical School. 

In a June 6 opinion piece published in The Washington Post, Dr. Kahn, who also practices at Beth Israel Deaconess Medical Center in Boston, said biopsychosocial biopsies, which collect "samples" of a patient's biographical, psychological and social worlds are valuable in making patients feel more comfortable. 

A biopsychosocial biopsy begins with asking patients four questions: 

  1. Where and with whom do you live?
  2. How do you spend your days?
  3. Who are the important people in your life?
  4. What sorts of things give you pleasure?

While physicians don't hesitate to perform invasive procedures or examinations on patients' bodies, they're often reluctant to inquire about who patients are as people, exemplifying a widespread medical paradox, Dr. Kahn said. 

"We manually examine prostate glands and uteruses, stick needles and catheters hither and yon, and overcome squeamishness to get detailed descriptions of bowel habits and genital problems. But ask about a breakup? That's getting too personal," he wrote. 

"The problem is that these personal matters are what many patients … often need and want to talk about," he added. "When patients know their doctor knows even a little about their personal life, they usually feel calmer and better understood." 

Using the aforementioned four questions as a starting point helps gauge patients' comfort in moving forward with a deeper conversation, the psychiatrist said.

"Just as the opening moves of a chess game may be predictable, providing a framework for each player to follow until things settle down and get more interesting, the biopsychosocial biopsy aims to get doctors comfortably through the 'opening game' of personal inquiry," Dr. Khan wrote. "From there the doctor has the choice about whether and how to take things further, guided by experience and empathy." 

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