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Rethinking Medicine: Improving Health Outcomes With Cost-Effective Psychosocial Interventions

Sobel, David S. MD, MPH

Special Issue: Superhighways for Disease

Thoughts, feelings, and moods can have a significant effect on the onset of some diseases, the course of many, and the management of nearly all.Many visits to the doctor are occasioned by psychosocial distress. Even in those patients with organic medical disorders, functional health status is strongly influenced by mood, coping skills, and social support, yet the predominant approach in medicine is to treat people with physical and chemical treatments that neglect the mental, emotional, and behavioral dimensions of illness. This critical mismatch between the psychosocial health needs of people and the usual medical response leads to frustration, ineffectiveness, and wasted health care resources. There is emerging evidence that empowering patients and addressing their psychosocial needs can be health and cost effective. By helping patients manage not just their disease but also common underlying needs for psychosocial support, coping skills, and sense of control, health outcomes can be significantly improved in a cost-effective manner. Rather than targeting specific diseases or behavioral risk factors, these psychosocial interventions may operate by influencing underlying, shared determinants of health such as attitudes, beliefs, and moods that predispose toward health in general. Although the health care system cannot be expected to address all the psychosocial needs of people, clinical interventions can be brought into alignment with the emerging evidence on shared psychosocial determinants of health by providing services that address psychosocial needs and improve adaptation to illness.

From the Regional Health Education Department, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, California.

Address reprint requests to: David S. Sobel, MD, Regional Health Education, Kaiser Permanente Medical Care Program, 1950 Franklin St., 17th Floor, Oakland, CA 94612.

Received for publication June 2, 1994; revision received October 25, 1994

Copyright © 1995 by American Psychosomatic Society
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