Bio-psycho-social formulation... do you routinely do this?

[fiatslug]

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I'm all about the dictation template . I want to continue to use the bio-psycho-social formulation in my assessment, because (a) I think it's a good way to think through the case and (b) I think (?) it probably helps to be in the habit of doing this for oral boards. What do you include? What am I forgetting? I know I often blur the psycho-social stuff. I've never found a really good source for understanding this better.

Biological:
-fam hx/genetic loading
-medical conditions that could be contributing to sx
-substance use/abuse that could be contributing to sx
-medications that could be contributing to sx
-seasonal component to sx

Psycho:
-recent stressors/triggers
-conflict with family/work
-defenses in use

Social:
-working or not
-living alone/with family
-in school or not
-relationship status

 

[Manicsleep]

I'm all about the dictation template . I want to continue to use the bio-psycho-social formulation in my assessment, because (a) I think it's a good way to think through the case and (b) I think (?) it probably helps to be in the habit of doing this for oral boards. What do you include? What am I forgetting? I know I often blur the psycho-social stuff. I've never found a really good source for understanding this better.

Biological:
-fam hx/genetic loading
-medical conditions that could be contributing to sx
-substance use/abuse that could be contributing to sx
-medications that could be contributing to sx
-seasonal component to sx

Psycho:
-recent stressors/triggers
-conflict with family/work
-defenses in use

Social:
-working or not
-living alone/with family
-in school or not
-relationship status

Make sure to have a temporal context. I've used the predisposing, precipitating and perpetuating paradigm in the past.

Here is a short and easy read on the subject.

http://www.amazon.com/Biopsychosocial-Formulation-Manual-Mental-Professionals/dp/0415951429

 

[beezley]

Along with those other Ps I include protective factors. Like NO substance use or 'in good physical health'.

Also, under psychological if it is relevant I might include their Erikson stage. Family and work or lack thereof I put under social. The psychosocial definitely blurs but I try to keep psychological things like recent loss, trauma, or protective things like, 'finds deep meaning in work', or 'large amount of identity/pride related to being a mother'. And also coping mechanisms, whether they are constructive (artwork) or destructive (cutting, drinking).

Sorry if that was rambling it was a long day.

 

[fiatslug]

Great suggestions, thanks--I'll put that book on my "second real paycheck" list (the first is already spent🙄). I too have trouble with blurring the psychosocial. I like the idea of including the Eriksonian stages.

 

[whopper]

I'd add several things to the psychosocial...

• Identification of maladaptive or helpful coping strategies, schemas
• Identification of defense mechanisms--specify if mature or immature
• Identification of any cognitive issues
• Mention how these issues are affecting each other. E.g. some things go in a positive feedback loop....Person gets angry, then because they're angry the person could be even more likely to be set off by other things....

 

[Shikima]

To give a short answer for your question: No. Too dang busy.

 

[Manicsleep]

To give a short answer for your question: No. Too dang busy.

As a resident?

 

[Shikima]

As a resident?

Yup, as a resident. Faculty shortage and the slack is picked up by the residents.

 

[Manicsleep]

Yup, as a resident. Faculty shortage and the slack is picked up by the residents.

Contact the ACGME