Systems thinking and the biopsychosocial approach: A multilevel framework for patient‐centred care

Abstract

AbstractPatient‐centred care is an approach intended to include service‐users' needs and perspectives as crucial aspects of clinical treatment, superseding any attempt to paternalistic and unilateral attitude in the therapeutic relationship. It is a call to think about persons and not simply of their diseases and implies the adoption of a biopsychosocial perspective and shared decision making. Nonetheless, thinking about persons inevitably means taking the context into due consideration, as individuals are not isolated and any kind of illness experience cannot be thought as a simple matter of inner thoughts and feelings. This perspective article builds on the core tenets of systems thinking and the biopsychosocial approach, with the aim of developing a multilevel approach to patient‐centred care. Within this framework, a literature review has been conducted to gather relevant research findings concerning each level of analysis and the interrelations of such levels.Systems thinking is an ideal framework for capturing the multilayered aspects of illness, from the biological processes that lead to a given disease to the social context where people live. From this angle, we can argue that systems‐centred care is the framework we actually need to truly accomplish patient‐centred goals. This means seeing people as complex dynamical systems and always bearing in mind the ecology of their lives. This also means gearing research and clinical practice towards this direction because complex phenomena like health require adequate methods of inquiry and treatment plans. A multilevel approach is the main road to effective and enduring outcomes. On the contrary, fragmentation of knowledge and excessive specialization without integration can pave the way to short‐term solutions and weak or vanishing improvements in the long run, with obvious costs for persons, families and the community.