Integrating the Stott and Davis model with the biopsychosocial–spiritual framework: a comprehensive approach to clinical reasoning in primary care

Contemporary healthcare increasingly requires clinicians to deliver person-centred, holistic care within complex and resource-constrained environments. Although the biopsychosocial–spiritual (BPSS) model provides a comprehensive theoretical basis for understanding patient needs, its practical application in routine consultations remains inconsistent, particularly in time-limited settings. Similarly, structured consultation models such as Stott and Davis support organisation and efficiency but do not explicitly integrate holistic dimensions of care. There is a need for a clinically and educationally relevant framework that integrates these approaches with structured clinical reasoning to support everyday practice. This conceptual paper proposes an integrated framework that combines the BPSS model, the Stott and Davis consultation model, and the Clinical Reasoning Cycle (CRC). The framework aligns the four tasks of the Stott and Davis model with the iterative stages of clinical reasoning, while embedding biological, psychological, social, and spiritual considerations across all phases of the consultation. It is designed as both a practical tool to guide clinicians in delivering comprehensive, structured care and a pedagogical framework to support teaching, learning, and assessment. The proposed framework provides a structured yet flexible approach to clinical consultations, enabling clinicians to systematically address acute and chronic conditions, integrate health promotion, and account for the broader patient context. In medical education, it offers a coherent scaffold for teaching integrated clinical reasoning and consultation skills while promoting reflective practice and professional development. By explicitly incorporating sociocultural and spiritual dimensions, the framework supports culturally responsive and patient-centred care. It is particularly applicable in primary care and diverse, resource-limited settings characterised by multimorbidity and complexity. This integrated framework contributes to theory-building by bridging structured consultation models with holistic care paradigms in a way that is directly applicable to clinical practice. It offers a coherent approach to both delivering and teaching comprehensive, person-centred care. Further empirical research is required to evaluate its feasibility, acceptability, and impact on clinician performance, learner outcomes, and patient care.