3. Capita selecta

1. Introduction

The aim of this third and final part of this book is to provide insight into the fundamental principles of the BPS-model in health care. This insight enables OBGYN professionals to put women’s healthcare problems in different perspectives and to use the capacities of many disciplines to help women to resolve them. Although the importance of this approach was already noticed in the early fifties of the last century by eminent colleagues as Balint and Engel, its full merit becomes more and more visible in our current era of empowerment and connectivity. Each day it becomes mere clear that most patients don’t need a God to treat them but a professional to guide them (Bloem, 2012) and that is exactly what the BPS-model supports.

2. Back to the future

Within the OBGYN domain the cultural trend towards patient empowerment  and multidisciplinary co-creation was already understood in second half the last century. For over 30 years the International Society for Psychosomatic O&G (ISPOG) advocates an ideology that sees women patients as a subject and not as an object. No matter which health related problems she has to face, the patient is and will always be a woman who caries responsibility for  herself and who has her own cultural background and life history. Within ISPOG therefore always has been a great interest in health literacy, especially  what Lauret (1994) referred to as liberating literature and participation in social support networks. Because nowadays patients are expected to set their own goals and to choose their own way of problem solving within, but especially where lives are lived, outside the consultation room or hospital wards, the bio-psycho-social perspective is rapidly gaining importance. The patient of the future is the ‘ISPOG patient’ of the last 30 years!

3. More transitions

In order to keep up with our patient and to become highly valued guides and co-creators, not only workers in ObGyn have to transform but also the organisations we are part of like (teaching) hospitals and (university) clinics. To meet the growing needs in terms of safety and quality on the one hand and innovation and ownership at the other, the concept of Clinical Governance has been developed. With its ‘striving for integrated care and a system theoretical view on patients (micro level) as well as on health care organisations (macro level)’ it shares the same ideological roots as psychosomatic medicine (vdW, WWs & Heineman, JPOG). Thirty years of ISPOG experience has learned us that CG depends heavily on the knowledge, competence in medical management, leadership qualities and  especially active participation in the process of governance of health care professionals themselves. What is relevant for patients is therefore, mutate mutandis, also relevant for us.

4. Personal growth

Being an expert in a small part of OBGYN is no longer enough. In order to establish the depicted growth, integration has to take place of personal knowledge and skills into so called competencies. A competency is, in summary, the ability of a person to do a job properly. From this perspective the bio psych social approach does not distinguishes itself so much by doing different things, but by doing things differently. POG offers a better fit to the patients needs and context by emphasizing other aspects and/or using other sequences of normal medical ‘building bricks’.

In part 2 we have used the Canmeds roles as general building bricks in order to tailor our work in an architectural way. Each disease or complaint requires a different building plan. By not only asking authors to share with us their architectural knowledge but also their views on competency profiles, we could sketch more general preconditions that have to be met in order to treat patients in a bio-psycho-social way. The ‘disadvantage’ of this approach is that it requires also a sort of implicit data base of what Polanyi (1958) called personal or tacit knowledge. In order to provide this data base in this part 3, more fundamental knowledge is connected to:

A. a historical desciption of trends in medicine, using patient education and the way it's taught as an illustration;

B. a cross sectional description of representative themes of POG, classified in terms of the Canmeds competencies that integrate them:

  1. A gynaecologist who did not know where to start; about managing psychosomatic problems. ;To manage health care doing justice to its character as a complex and costly system on the one hand, and to the people who work in it on the other; a new interpretation of the bio-psycho-social model is described
  2. A surgeon in doubt; about ethical dilemma’s and moral decisions. To reflect on ethical and political questions about health and health care, about how to relate ourselves to the condition humaine of disease, vulnerability and death a model of moral medical decision making is presented, using the female genital cosmetic surgery as an illustration;
  3. A psychologist who forgot to tell stories; about patient education. To communicate with patients in a far more interactive and reciprocal way in order to empower them the CELI-model of patient education is proposed;
  4. A midwife who had a conflict with an obstetrician; about contact-tics and con-tactics. To collaborate with colleagues in a way that is no longer characterised by being eminent as an ego, but that establishes true co-creation in highly reliable teams and organisations, the Leary model is applied to the collaboration between midwives and gynaecologists; 
  5. An obstetrician in trouble; about second victimization. To enhance the impact of our education from improvement, through innovation onto the level of personal and scientific growth the cognitive adaptation model is applied to the support of ObGyn colleagues as second victims
  6. A psychiatrist as an equilibrist; about balancing in unusual positions. To establish a level of work that meets the highest patient and societal demands, professionalism is a sine qua non as will be advocated in terms of coping with a number of fundamental but unavoidable dilemma’s;
  7. A gynaecologist who has to integrate working with head, hands and heart; about examinations. To integrate all the above tasks and roles into visible medical expertise, the gynaecological examination will be discussed in detail.