Functional illness in primary care: dysfunction versus disease

<p>Abstract</p> <p>Background</p> <p>The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness.</p> <p>Discussion</p> <p>This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change.</p> <p>Summary</p> <p>We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness.</p

Leadership Matters: Tensions in Evaluating Leadership Development

The Problem. This article explores some of the tensions that required careful management in the design and delivery of a leadership development program. This discussion draws particularly upon a formal evaluation of two cohorts, each comprising approximately 20 senior managers working in adult social care. Complexity theory, notably Complex Responsive Processes of Relating, is used to make visible, explore and articulate the need to hold in tension apparently contradictory forces and requirements. The program was established at a critical time in the U.K. government's public services reform agenda, which was unfolding during a period of increasing resource constraint. This included a requirement upon commissioners to demonstrate impact and return on investment (ROI) in development programs. However, complexity theory explains why a direct causal relationship between inputs and outcomes is not amenable to demonstration by evaluation. The Solution. Consequently, the approach to demonstrating ROI explored the microprocesses underpinning the development of the participants' thinking and practice through formative real time and post hoc evaluation. This comprised a range of qualitative techniques: extended observations provided an "ethnographic" overview of the program; participant and stakeholder interviews gave insight into critical incidents and key learning points; and guided conversations placed greater emphasis on the everyday experience of participants in applying their learning. It is argued that such an approach to evaluation is both a research intervention and a contribution to the development process. The Stakeholders. Our article will be of particular relevance to human resource professionals, leadership development practitioners, commissioners, business schools and evaluators facing the challenge of finding meaningful measures of "ROI" for individual and organizational development. © 2013 SAGE Publications