The medical model of health is a negative one: that is, that health is essentially the absence of disease. Despite bold attempts by bodies such as the World Health Organisation (WHO) to argue for a definition of health as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’, most medically related thought remains concerned with disease and illness.
-The main point of this model of disease is that it attempts to uncover underlying pathological processes and their particular effects.
-The pathologically based and causally specific medical model became increasingly dominant. In the medical model of disease, tuberculosis is defined as a disease of bodily organs following exposure to the tubercle bacillus. The development of the illness involves symptoms such as coughing, haemoptysis (coughing up blood), weight loss and fever. In this model the underlying cause of the illness is the bacillus, and its elimination from the body (through anti-tubercular drugs) is aimed to restore the body to health.
-In the case of tuberculosis, the symptoms described above are also found in other diseases, and this problem of linking symptoms to specific underlying mechanisms frustrated medical development.
-Today, these are often referred to as forms of ‘complementary medicine’ – herbalism and homeopathy, for example – that treat symptoms ‘holistically’ – but do not rest on the idea of underlying, specific pathological disease mechanisms.
-The medical model was essentially individualistic in orientation and, unlike earlier approaches, paid less attention to the patient’s social situation or the wider environment. This narrowing of focus (towards the internal workings of the body, and then to cellular and sub-cellular levels), led to many gains in understanding and treatment, especially after 1941, when penicillin was introduced, and the era of antibiotics began. But it was also accompanied by the development of what Lawrence calls a ‘bounded’ medical profession, that could pronounce widely on health matters and could act with increasing power and autonomy. Doctors now claimed exclusive jurisdiction (authority) over health and illness, with the warrant of the medical model of disease as their support.
This situation meant that modern citizens were increasingly encouraged to see their health as an individual matter, and their health problems as in need of the attention of a doctor. It is this which Foucault (1973) saw as constituting the ‘medical gaze’ which focused on the individual and on processes going on inside the body – its ‘volumes and spaces’. Wider influences on health, such as circumstances at work or in the domestic sphere, were of less interest to the modern doctor. This ‘gaze’ (extended in due course to health-related behaviours) underpinned the development of the modern ‘doctor-patient’ relationship, in which all authority over health matters was seen to reside in the doctors’ expertise and skill, especially as shown in diagnosis. This meant that the patient’s view of illness and alternative approaches to health were excluded from serious consideration. Indeed, the patient’s view was seen as contaminating the diagnostic process, and it was better if the patient occupied only a passive role.
It is for this reason that the ‘medical model’ of disease has been regarded critically in many sociological accounts. The power of the medical model and the power of the medical profession have been seen to serve the interests of ‘medical dominance’ rather than patients’ needs (Freidson 1970/1988, 2001) and to direct attention away from the wider determinants of health. However, before we proceed, two caveats need to be entered. Whilst medicine in the last 20 years has continued to focus on processes in the individual body, such as the chemistry of the brain or the role of genes in relation to specific diseases, the current context is clearly different from that which existed at the beginning of the twentieth century. Today, in countries such as the UK and the USA, infectious diseases are of far less importance as threats to human health.
The biopsychosocial model in medical research: the evolution of the health concept over the last two decades
1. Introduction
The traditional biomedical paradigm has its roots in the Cartesian division between mind and body, and considers disease primarily as a result of injury, infection, inheritance and the like. Although this model has been extraordinarily productive for medicine, its reductionistic character prevents it from adequately accounting for all relevant medical aspects of health and illness [1 and 2]. One of the most criticised consequences of adopting the biomedical model is a partial definition of the concept of health. If disease consists only of somatic pathology-or, more strictly and according to the influential work of Virchow [3], cellular pathology-health must be the state in which somatic signs and symptoms are not present. According to this view, the World Health Organization defined health simply as the “absence of disease” [4].
In his classic papers, Engel [1 and 5] explicitly warned of a crisis in the biomedical paradigm and conceptualised a new model which regards social and psychological aspects as giving a better understanding of the illness process [6]. In recent years, the so-called biopsychosocial model has found broad acceptance in some academic and institutional domains, such as health education, health psychology, public health or preventive medicine, and even in public opinion. It is now generally accepted that illness and health are the result of an interaction between biological, psychological and social factors [7, 8 and 9]. Many authors now include mental and social aspects in their definitions of health [10, 11, 12 and 13].
It might be expected that, in the two decades since Engel’s call for a biopsychosocial framework, the concept of health implying social and psychological components would also have extended to practical contexts. The purpose of the present study is to find out whether and to what extent the biopsychosocial concept of health has spread among medical researchers.
4. Discussion and conclusions
In western culture, at least since the advent of Cartesian dualism, medicine has used a mechanistic approach to human nature and has centred its interest around illness and its signs.
-The main reason for the failure of psychological and social measures in the reports examined lies in the still deep-rooted dominance of the biomedical model which, despite the criticism of its reductionism, remains useful and still enables advances in medicine. This dominance has surely been reinforced in recent years because of the push of genetic research and therapies. Perhaps, holistic and biological-reductionistic models should not compete but try to coexist, as two different but not necessarily incompatible possibilities for approaching health questions. The result would be, however, a reduction of biomedical terrain. First, clinical and health psychology have demonstrated their capacity to explain and treat many somatic symptoms. Second, some holistic medical models-such as Traditional Chinese Medicine or Hanneman’s homeopathy-are gaining ground because of patients who do not find satisfactory solutions in biomedical care. Third, biomedical care implies enormous and rapidly-rising costs that are beginning to exceed the budget of the health care systems.
4.2. Practice implications
The biopsychosocial model has been successfully applied to obtain a better understanding of the disease processes and their causes [18], and also for public health purposes [19 and 20], or to improve physician-patient relations [21 and 22], but medical practitioners are still reluctant to incorporate it into treatment plans [16]. Holistic approaches remain till now restricted to chronic illness management [23], which is the field of medical care where regaining health, in a biomedical sense, is not the main goal.
For the medical practitioner, the difficulties attached to the change from a biomedical to a biopsychosocial model of health can be well understood. First, this change necessarily implies taking into account a much wider spectrum of the factors influencing health and the healing process, which in turn demands greater knowledge and time investment. Second, the new paradigm implies a new style of the patient-doctor relationship, a style which enables, among other things, the doctor’s attention to the patient’s psychosocial circumstances, in order to better manage his or her situation, and not only his or her illness. Undoubtedly, this kind of interaction requires a greater effort from practitioners, but also from the health care systems, which should provide the necessary context and resources for it, such as communication skills training, adequate settings, or enough personnel.
Despite these hindrances, which will probably continue to relegate the biopsychosocial model to a secondary place in medical practice, the broadening of the doctor’s perspective to encompass psychological and social aspects would be really beneficial for the patient, since as Engel [24] lucidly pointed out, even though both patient and doctor may culturally adhere to the biomedical model, the patient’s needs and ultimate criteria are always psychosocial.
What Is the Biomedical Model? (wise geec)
The biomedical model is a theoretical framework of illness that excludes psychological and social factors. Followers of this model instead focus only on biological factors such as bacteria or genetics. For example, when diagnosing an illness, most doctors do not first ask for a psychological or social history of the patient. The biomedical model is considered to be the dominant modern model of disease.
According to this model, good health is the freedom from pain, disease or defect. It focuses on physical processes that affect health, such as the biochemistry, physiology and pathology of diseases. It does not take social or psychological factors into account.
The biomedical model is often referred to in contrast with the biopsychosocial model. In 1977, George L. Engel published an article in the well-known journal Science that questioned the dominance of the biomedical model. He proposed the need for a new model that was more holistic. Although the biomedical model has remained the dominant model since that time, many fields, including medicine, nursing, sociology and psychology, use the biopsychosocial model at times. In recent years, some professionals have even begun to adopt a biopsychosocial-spiritual model, insisting that spiritual factors must be considered as well.
Proponents of the biopsychosocial model look at biological factors when assessing and treating patients, just like users of the dominant model do. They also look at other areas of patients’ lives, however. Psychological factors include mood, intelligence, memory and perceptions. Sociological factors include friends, family, social class and environment. Those who examine spiritual factors also assess patients based on their beliefs about life and the possibility of a higher power.
Scholars in disability studies describe a medical model of disability that is part of the general biomedical model. In this medical model, disability is an entirely physical occurrence. According to the medical model, being disabled is negative and can only be made better if the disability is cured and the person is made normal.
Many disability rights advocates describe a social model of disability, which they prefer. This social model opposes the medical model. In the social model, disability is a difference – neither good nor bad. Proponents of the social model see disability as a cultural construct. They point out that a person’s experience of disability can decrease through environmental or societal changes, without the intervention of a professional and without the disability being cured.
Explain the main determinants of health: age, sex and hereditary factors, lifestyle, housing, social class etc.:
The determinants of health
Introduction
Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.
The determinants of health include:
the social and economic environment,
the physical environment, and
the person’s individual characteristics and behaviours.
The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants-or things that make people healthy or not-include the above factors, and many others:
Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
Education – low education levels are linked with poor health, more stress and lower self-confidence.
Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.
Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
Health services – access and use of services that prevent and treat disease influences health
Gender – Men and women suffer from different types of diseases at different ages.
Success of NHS was also its Achilles heel – demand increased
The scale and nature of the problem:
Incidents involving incorrect medication dosage
Incidents involving the use of technical procedures
A number of women became pregnant following failure of earlier sterilisations which had been carried out by laparoscope (keyhole surgery). The surgeon had attached the sterilisation clips to the wrong part of the Fallopian tube.
Incidents involving failures in communication
A man admitted to hospital for an arthroscopy (an exploratory operation) on his knees had a previous history of thrombosis (blood clots). This was noted by a nurse on his admission form, but was not entered on the operation form which had a section for risk factors and known allergies. The operation was carried out and the patient was discharged from hospital the same day. Given his history of thrombosis the patient should have been given anticoagulant drugs following his operation, but because his history had not been properly recorded none were given. Two days later he was admitted to the intensive care unit of another hospital with a blood clot in his lungs
The impact of adverse events on individuals
2.15 Adverse events involve a huge personal cost to the people involved, both patients and staff. Many patients suffer increased pain, disability and psychological trauma. On occasions, when the incident is insensitively handled, patients and their families may be further traumatised when their experience is ignored, or where explanations or apologies are not forthcoming. The psychological impact of the event may be further compounded by a protracted, adversarial legal process. Staff may experience shame, guilt and depression after a serious adverse event, which may again be exacerbated by follow-up action. [20,21]
2.16 The effect of adverse events on patients, their families and staff is not sufficiently appreciated and more attention should be given to ways of minimising the impact of adverse events on all those involved. These issues, while of great importance, cannot be fully addressed within this report and may require separate attention, though we made some limited comment in the context of our discussion on litigation in chapter 4.
Conclusion
Information on the frequency and nature of adverse events in the NHS is patchy and can do no more than give an impression of the problem. Information from primary care is particularly lacking;
The financial costs of adverse events to the NHS are difficult to estimate but undoubtedly major – probably in excess of £2 billion a year;
There is evidence of a range of different kinds of failure, and of the recurrence of identical incidents or incidents with similar root causes;
Case studies highlight the consequences of weaknesses in the ability of the NHS as a system to learn from serious adverse events;
There is a need for further work focusing specifically on how the impact of adverse events on patients, their families and staff can be minimised.
From the ‘cradle to the grave’, increasing aging population etc:
Britain’s population is ageing fast, with statisticians predicting a huge increase in the number of 100 year olds by the next century.
With people living longer and longer because of medical and other advances, health experts believe the number of people suffering from debilitating conditions such as cancer and heart disease will grow and could mean a rising demand for nursing care.
Health experts are worried that as people get older, they could become prone to an increasing number of debilitating conditions if they do not keep active.
The WHO has launched a campaign to promote good health in old age.
Doctors in the UK say people have an over-gloomy picture of old age and that there is no reason why they should have a lower quality of life than other people if they keep healthy.
People do have anxiety that there will be a period of disability at the end of their lives.
“But there is no evidence that that is the case if they are encouraged to live a healthy life and this generation of elderly people are in better nick than the previous generation.”
Beating the ageing process
Organisations which campaign for the elderly are in favour of policies which support old people to be as independent as possible and allow them more choice and power over their future. They say cuts in local authority and health budgets mean services like home helps have been “whittled (cut) away”.
Without a boost in those services which support independence, there is likely to be increasing pressure on those that cater for dependence: our hospitals, nursing and residential homes.”
The organisation wants a national strategy which sets a framework that encourages independence and inclusion. It says that such a strategy would be much cheaper than putting people into care homes.
They want to see a wider debate on issues such as who funds long-term care, rationing of care – particularly in the light of increasing technological change, and health promotion.
They argue that the present division between social and health services over long-term care is “artificial and damaging”.
It means people in places funded by social services have to contribute towards their care costs, whereas those in places funded by the NHS get free care.
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