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Since the first edition of Behavioral Medicine was published in 1997, there have been considerable advances in medical diagnosis and treatment, as well as changes in the ways in which health care is organized and delivered. The science of genetics is revolutionizing the understanding of disease and the design of therapies targeted to specific diseases. New medications are available for treatment of a variety of health problems, including heart disease, hypertension, and depression. Hospital medicine has arisen as an area of expertise within general internal medicine, and palliative care has emerged as the care of the dying has developed into an array of therapies requiring special knowledge and skills. There are new models of chronic care and patient self-care that increase effectiveness in the treatment of those with chronic illness.

This new edition of Behavioral Medicine addresses these and other developments in the integration of social and behavioral science with health care. We have broadened the scope of our chapters to include the hospital as well as ambulatory settings, and case examples are drawn from both domains of practice. We have added reference to themes such as the relation of religion and spirituality to health, the practice of mindfulness both in addressing health outcomes for patients and in promoting the well-being of clinicians, and the evidence base for behavioral interventions. Chapters from the previous editions have been updated to reflect advances in pharmacotherapy and evidence on the relationship between psychosocial factors and disease. For example, we have included new evidence on depression as a risk factor for heart disease and diabetes. New chapters on mindfulness, attention deficit hyperactivity disorder, vulnerable patients, and chronic illness have enhanced our coverage of topics useful to clinicians.

The training of physicians and other health professionals has also evolved during the past decade. Education for professionalism—embodying the core values motivating patient care and the quality of interactions with patients, colleagues, and staff—has taken root in many training institutions. Medical educators are beginning to attend consciously to the "hidden curriculum," the set of implicit verbal and nonverbal messages that may enhance or erode the highest ideals of the health care professions. Another growing phenomenon is the increased number of international medical graduates entering training in U.S. residencies. Many of these graduates have trained previously in settings that have not emphasized the social and behavioral aspects of health care, and their needs for additional training and support in the relational aspects of patient care are evident. Finally, helping trainees in the health professions to find balance in their lives and to develop the life skills for a sustainable career has challenged medical schools and residencies to create curricula and educational experiences to promote well-being. To address these developments, we have added a new section on teaching behavioral medicine.

Although the term "behavioral medicine" is used widely in both medical and social science literature, there is little agreement as to its exact definition. We broadly define it as an interdisciplinary field that aims to integrate the biological and psychosocial perspectives on human behavior and to apply them to the practice of medicine. Our perspective includes a behavioral approach to somatic disease, the mental disorders as they commonly appear in medical practice, issues in the clinician-patient relationship, and other important topics that affect the delivery of medical care, such as motivating behavior change, maximizing adherence to medical treatment, complementary and alternative medicine, and care of the dying.

We hope that general internists, hospitalists, family practitioners, pediatricians, nurse practitioners, physician assistants, and other clinicians will find that this book helps them to better understand and care for persons with a wide variety of mental and behavioral problems. For residents and students in health care settings, Behavioral Medicine: A Guide for Clinical Practice can function as a valuable resource for understanding the psychosocial dimensions of medicine in much the same way that Current Medical Diagnosis & Treatment helps them to understand the biomedical domain.

It is our intent that medical educators will find this book to be a clinically relevant text that forms a basis for developing a comprehensive curriculum in behavioral medicine. Training in the core competencies required by the Accreditation Council for Graduate Medical Education (ACGME) will be enhanced by inclusion of topics covered thoroughly in this book, including clinician-patient communication, professionalism, and cultural competence. For faculty and students who wish to explore a topic in greater depth, the suggestions for further reading and web-based resources provided at the end of each chapter will be helpful.

The principles of behavior change discussed in this book may be applicable beyond the behavior of individuals; they apply to whole societies as they move through the "stages of change" to alter lifestyles that adversely impact the environment and human health. The health and well-being of our personal lives and of the organizations where we work are intertwined with the health of our planet. Being mindful of the factors that promote environmental health can give us insights into the sustainability of our lives and careers in medicine. Land use planners use the equation C – L = M (Capacity – Load = Margin) when determining sustainable human population growth. Capacity refers to the carrying capacity of the land, which includes available water, natural resources, transportation corridors, and the ability of the land to absorb the wastes of human activity. Load refers to the impact or "ecological footprint" of that human activity upon the land. When the carrying capacity of the natural environment is greater than the additional load of human activity, then there will be a positive margin and population growth is sustainable. Conversely, when the load exceeds the capacity of the land, then there is a negative margin and growth is unsustainable.

This same equation, C – L = M, can be applied to our own lives and the organizations where we work. When work, family, and other commitments chronically overload our own capacity, then we are in a negative margin state, another way of defining burnout. Conversely, when our capacity exceeds the load, we are in a positive margin state, and our lives are sustainable and healthy. Restoring the proper relationship of humans with the earth in a way that promotes sustainability in the whole system is what Thomas Berry has called "the great work" of our generation. Physicians and other health professionals have a vital role to play in this work, for our own health and well-being will only be as good as the health of the planet.

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