['TESTED, BUT NOT TRIED' - WHY IS BEHAVIORAL MEDICINE RARELY IMPLEMENTED IN CLINICAL PRACTICE?].

BACKGROUND: Behavioral Medicine is an inter-disciplinary field concerned with the integration of behavioral and biomedical knowledge for the purposes of diagnosis, prevention, treatment and rehabilitation of conditions pertaining to health and illness. Behavioral treatments (such as: hypnosis, relaxation training, meditation, biofeedback and cognitive-behavioral therapy) have been shown to be effective in reducing physical symptoms as well as improving health-related behaviors and quality of life across a wide variety of illnesses, such as: chronic pain, somatic symptoms, diabetes, inflammatory bowel diseases, coronary heart disease and more. The usefulness of behavioral techniques in modern medicine has been sufficiently proven so as to have been referred to as the "third therapeutic revolution" in treating human illness, after pharmacological and surgical treatments.

THE PROBLEM: Despite the fact that the bio-psycho-social model is the dominant model in 21st century medicine and despite the plethora of studies demonstrating the efficacy of behavioral interventions, these tools are underused in today's medical system. The reasons for this have to do with a dichotomous view of mind and body rooted in the biomedical approach, which was the dominant paradigm in the medical world up until the latter half of the previous century. In accordance with this paradigm, diseases were "assigned" either to medicine (i.e. they are physiological) or to the mental health professions (i.e. they are psychological), but never to both fields simultaneously. As an extension of this position, behavioral medicine was not included in Israel's socialized health care plan, making the use of behavioral techniques largely impractical, so that even physicians who agree with and believe in the importance of the bio-psycho-social model are often untrained or unable to provide effective behavioral treatments which would address the psycho-social aspects of their patients' illness.

DISCUSSION: In Israel today there exist a number of facilities which provide behavioral treatments, however, there is, as yet, no public body in charge of organizing and promoting the knowledge and use of behavioral medicine in Israel. For the sake of patients, physicians and the medical system itself, it is imperative that, in the future, medical and paramedical professionals, including students and interns, are exposed to and trained in the use of behavioral techniques. In addition, thought must be given as to the integration of such techniques in routine medical care. For that purpose, we propose a number of guiding principles for effectively implementing' behavioral techniques in the day-to-day practice of modern; medicine.