Realizing Engel's biopsychosocial vision: resilience, compassion, and quality of care

Int J Psychiatry Med. 2014;47(4):275-87. doi: 10.2190/PM.47.4.b.


George Engel's biopsychosocial vision was simultaneously scientific and humanistic. He passionately presented an approach to clinical care to correct the progressive distancing of clinical care and research from the lived experience of the patient. Yet, while science provides ever greater evidence for the linkages between subjectively-reported experience and health outcomes, trainees and practicing clinicians struggle to realize a biopsychosocial vision in a pragmatic way. These challenges are magnified by the mandate for greater patient autonomy and participation in care, increased access to information, and overlaps and omissions as multiple professionals try to address the whole person. Importantly, trainees and clinicians get stuck implementing the biopsychosocial model partly because they have not developed the capacity for resilience, self-awareness, and self-monitoring. These capacities must accompany efforts to help clinicians engage more deeply with their patients; otherwise, they risk emotional distress, empathic failure, premature closure, and withdrawal from effective connections with patients. This article will explore ways in which Engel's biopsychosocial vision can be realized through building the capacities of clinicians to become more self-aware and resilient, and engage in compassionate action.

Keywords: communication; patient-physician relations; philosophy of science; self-awareness.

MeSH terms

  • Empathy*
  • Humans
  • Physician-Patient Relations*
  • Quality of Health Care / standards*
  • Resilience, Psychological