A biopsychosocial model to complement a biomedical model: patient questionnaire data and socioeconomic status usually are more significant than laboratory tests and imaging studies in prognosis of rheumatoid arthritis.
Modern medical care is based largely on a paradigm known as a "biomedical model," in which a single "gold standard" high-technology test guides clinical care. Patients with hypertension, diabetes, osteoporosis, and many other conditions often are unaware of their status in the absence of data from "objective" tests. By contrast, in rheumatoid arthritis (RA) and most rheumatic diseases, patients generally are aware of symptoms, and information from patients often is as or more important to taking direct clinical decisions than laboratory tests, imaging studies, or even physical examination data. Physical function on a patient self-report questionnaire generally is as significant as, or more significant than laboratory, imaging, or physical examination data in predicting severe outcomes of RA, such as work disability, costs, and mortality. Patient questionnaires may be viewed as contributing to a complementary "biopsychosocial model" that can overcome limitations of the traditional "biomedical model" in RA and other chronic diseases. Further relevance of a "biopsychosocial model" in RA and other rheumatic diseases is seen in evidence that socioeconomic status, most easily assessed as formal education level, identifies favorable or unfavorable clinical status and prognosis at high levels of significance. Socioeconomic status may be regarded as a surrogate for the importance of patient actions, in addition to actions of health professionals, in the course and outcomes of rheumatic and other chronic diseases.
McCollum
Lauren
L
Division of Rheumatology, Department of Medicine, New York University School of Medicine and NYU Hospital for Joint Diseases, 301 East 17th Street, Room 1608, New York, NY 10003, USA.
Pincus
Theodore
T
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D015897:Comorbidity; D004185:Disability Evaluation; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires