The Biopsychosocial Formulation

Abstract

The biopsychosocial formulation is an approach to understanding a patient that takes into account biological, psychological, and social perspectives on the patient's current presentation. Such an approach is especially important for patients with complicated presentations. Given current trends in service delivery, including the growing role of primary care physicians and mid-level providers, it is likely that in the future the majority of patients triaged to psychiatrists for diagnosis and treatment will be highly complicated. Psychiatrists must have the clinical skills to identify pertinent data from the vast array of data available to them, develop a set of hypotheses that illustrate their understanding of each patient from multiple perspectives, and use these hypotheses to develop an individualized treatment plan. The biopsychosocial formulation, as described by Engel, is an approach to developing these hypotheses. For international medical graduate (IMG) physicians undergoing residency training, and especially for those physicians who have completed a residency in another country, learning to complete a biopsychosocial formulation may challenge their already well-established approach to patient care. This chapter aims to describe useful ways to approach the teaching of this important skill. Special emphasis will be given to the psychological and social aspects of formulation, as these dimensions are challenging for all residents, including IMG physicians. In addition, an extended discussion of the cultural formulation is presented. Although this perspective should be conceptualized as a part of the social formulation, the cultural formulation has a unique history and approach. The cultural formulation is a tool that some IMG physicians may find particularly helpful, as it provides a principle-based framework by which they can better understand cross-cultural doctor-patient interactions. Although not an exhaustive review of formulation, this chapter will communicate the principles and spirit by which the process and pedagogy of the biopsychosocial formulation can be effectively approached. (PsycInfo Database Record (c) 2022 APA, all rights reserved)