Is it possible to bridge the Biopsychosocial and Biomedical models?

It is an honor to be invited to offer a perspective on our field for the official journal of the Japanese Society of Psychosomatic Medicine. As a past leader of the American Psychosomatic Society, I view this as an opportunity to continue building bridges regarding our common interests. One of the challenges of effective and meaningful communication in this context is being mindful of our similarities and differences. Awareness of differences can help to overcome communication challenges within our own field as well as when we seek to communicate and collaborate with our colleagues in other medical disciplines. To some of us it is obvious that biological, psychological and social factors are in reality integrated and that biopsychosocial medicine seeks to elucidate this reality. The biomedical, organ-based perspective focuses on disease mechanisms and assumes that the psychological and social are not essential to understanding and treating patients, although humanism in patient care is of course endorsed. Bridging these perspectives is important because the biomedical is the predominant model adopted by those who decide how to allocate health care dollars in the United States and many other countries. This in turn determines what clinical care is provided at the bedside. At the September 2013 meeting of the International College of Psychosomatic Medicine in Lisbon a tribute to George Engel was held. The symposium highlighted the value of the biopsychosocial model that he created and highlighted the limitations of the prevailing biomedical model. The predominant messages of the symposium appeared to be that the biopsychosocial approach had many advantages, it did not exclude the biomedical perspective, and that our biomedically-oriented colleagues should join us. The unfortunate reality is that in the 37 years since Engel’s seminal paper in Science [1] was published the integration of the biopsychosocial approach into everyday medical care hasn’t happened yet, and there is no sign in