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The fourth edition of this textbook would not have been possible without the groundbreaking achievements of Dr. George L. Engel who, among other things, introduced a new theoretical foundation for medicine in the biopsychosocial model. Research and education in the biopsychosocial tradition continue to this day and are reflected in such important publications as the Institute of Medicine’s influential report: Crossing the Quality Chasm. Dr. Engel also established the University of Rochester Program in Biopsychosocial Medicine (formerly the Medical–Psychiatric Liaison Group). Dr. Engel attracted and/ or trained many like-minded colleagues in this program; Art Schmale, Bill Greene, Bob Ader, Bob Klein, Joe Messina, Leon Canapary, Mack Lipkin, and Manual Brontman were key to Dr. Smith’s intellectual development and scholarship, first as a fellow and then as faculty in the program.

We also would like to thank our own universities (Yale, Michigan State, and Indiana) for encouraging us to publish the fourth edition of the book and for fostering education and practice in the Engel tradition. After Rochester, Michigan State was an early adopter of the model; Indiana and Yale have followed and are making dramatic impacts on the field. The book and other biopsychosocial work can occur only in such fertile environs.

We acknowledge the support of the Fetzer Institute in Kalamazoo, MI in providing the financial support to develop the method described in the book, the National Institute of Mental Health for their support of research that allowed us to demonstrate the effectiveness of the patient-centered approach, the Academy of Communication in Healthcare (ACH) for being a spiritual home for clinicians eager to improve relationships with patients and each other, and the Health Resources and Services Administration for recent generous support.

We are grateful for the opportunity to work with publisher Jim Shanahan, and his superb team at McGraw-Hill: Amanda Fielding, Senior Editor; Kim Davis, Managing Editor; Catherine Saggese, Senior Production Supervisor; and Anubhav Siddhu, Project Manager. Each has been remarkably helpful, diligent, and patient; this book is very much improved because of their efforts and attention to detail.

Finally, we would like to thank Drs. Mohamed Hassanein and Ashley Bartell for their help with the literature review.

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