Case Formulation After Engel—The 4P Model: A Philosophical Case Conference

摘要: The best known model for case formulation in the last 50 years was George Engel's Biopsychosocial model. It expanded compass of medical investiga- tion and it promised a scheme by which to organize clinical information more adequate understanding effective interventions. Despite its claimed advantages, has not been adopted clinicians. This article examines reasons this failure. argues therapeutic value (as complement diagnosis), presents an alternative schema clinicians can into four moments problem: origins (preconditions), precipitating factors, perpetuating protective factors. Unlike hierarchi- cally organized, synchronic schema, 4P is developmental, diachronic, clinically intuitive. encourages 'thick' formulations as basis wise treatment section describes two seminar series structure elements were presented third-year psychiatry residents.