Health may be defined as ‘the absence of disease and infirmary’ (Stroebe, 2000) or alternatively ‘not merely an absence of disease or infirmary but a state of complete physical, mental and social well-being (World Health Organisation, 1948). One definition more elaborate than the other, the latter suggesting health is effected by other factors that cannot be physically measured.
Since the start of evolution people have looked back to try to explain and understand the factors that influence human functions in relation to health and illness. Many theorists developed perspectives and models of health in order to show health professionals how to promote and improve health in society (Wade & Halligan, 2004). Two varying models of health, illness and disease will be discussed in this essay and how they could be applied to Dietetics. These models are the biomedical model and the biopsychosocial model. The use of one model over another in healthcare will be reflected on and the one most suitable for use in Dietetics will be highlighted.
The biomedical model of illness concentrates on the physical and biological traits of disease, and to cure these traits will cure disease (Engel, 1977). Biomedical theorists have a dualist belief in that the body is a machine only understandable subjectively by its compartments, separate from the mind (Morrisson & Bennet, 2006).
Much science today stemmed from knowledge of physical diseases from years ago that were treated quickly and efficiently using rules and rationales for treatment, with the resulting consequence being cure, control or death. This biomedical model of health dominated healthcare in the past century as all disease was thought to stem from cellular abnormalities (Wade & Halligan, 2004). It was exclusionist in its form in that those who suffered from various social deviation disorders, social adjustments reactions, character disorders, and dependency syndromes would be excluded from mental illness as these disorders arise in those with intact neurophysiological functioning (Engel, 1977). So what were the consequences of those who did not fit into this category? Unfortunately many were forgotten and ignored, or more extremely in the 1700’s shock tactics were used to bring them back to being ‘normal’ (Bernstein & Nash, 2008).
Alternatively following in a similar framework of the WHO’s definition of health, the biopsycholsocial model of health incorporates biological, psychological and sociocultural factors that contribute to someone’s health. It was Sigmund Freud who first looked at a person’s behaviour in the 1920’s and investigated how it may reflect their health status; although evidence was limited it built the ground work for interesting studies that would link personality to disease (Morrisson & Bennett, 2006). Convincingly, today, it is thought two-thirds of our behaviour can be linked to our health (Morrisson & Bennet, 2006).
The biopsychosocial model is both objective and subjective in its application. With this, a humanistic approach can be taken and it is thought that behaviour disorders appear when self-actualisation is blocked. The dietitian using this model would look at a person’s lifestyle, and social and cultural factors that affect the individual’s health behaviour. Reasons behind this behaviour can be established and methods for changing it to improve health can be established.
Dietetic assessment encourages the dietitian to identify with the patient potential and actual health problems. While some problems will be linked to specific medical conditions e.g. Chron’s Disease, others will be specific to individuals, their psychology and their social and cultural status e.g. obesity (Aggelton & Chalmers, 2000). In doing this the patient is more likely to comprehend and accept the advice and therefore comply with treatment.
If a biomedical model of assessment was used, a dietitian would be more interested in what is medically wrong with the patient, focus on signs and symptoms, and problems that arise from illness that can be solved. The dietitian would give a general list of rules for the obese patient to comply with to reduce their weight in a general hierarchical manner. Important questions such as, does the patient understand? Can they afford a healthier diet? and what resources do they need to help control further implications of their disease? would ultimately be neglected.
As one can see, the patient would have little or no responsibility of the cause of illness and therefore is classed as a victim of circumstance who becomes a passive recipient of treatment by using a biomedical model in consultations (Wade & Halligan, 2004). Engel (1977) supported the idea of using a biopsychosocial model in healthcare so as to give care and treatment holistically to patients. He suggests that by integrating an illness into someone’s life and showing them solutions to problems that may arise encourages a patient to see how they can cope with their illness or disease.
In a hospital the function of a multidisciplinary team is to see a disease from every disciplines point of view and to show how each discipline can contribute to the patient’s individual care and symptom management when living with their illness. This collaboration of ideas will look at medical, social, psychological, cultural, and physical aspects of care. The patient is more likely to engage and comply with interventions if they are happy with their treatment and the practitioners involved (Stroebe, 2000). However when using the biomedical model and setting orders for the patient, a patient-dietitian relationship may be effected which will cause strain on the overall patient outcome, e.g. if a patient’s concerns are neglected by a dietitian they are less likely to comply with treatment and more likely to get stressed on seeing that dietitian (Engel, 1977). Increase in stress levels like this can increase blood sugar levels and blood pressure during a hospital stay thus affecting a patient’s length of stay in hospital. The evidence suggests that a person’s emotional state always reflects their function and presentation of symptoms, hence using a biomedical model in assessment can lead to a practitioner ignoring potential route causes of a patients problem (Stroebe, 2000). A case in point is eating disorders.
There are so many avenues that contribute to an eating disorder and no single cause or symptoms can lead to diagnosis but a complex string of symptoms that will lead to a summative diagnosis (National Association of Anorexia Nervosa and Associated Disorders, 2010). A biopsychosocial model of health would help the practitioner to look beyond the patient sitting in front of them into the various factors in that patient’s life and how this may affect their eating habits and patterns. By delving further into this patient’s life the practitioner could get a wider picture of behavioural, psychological, cultural and environmental influences on these patients eating habits. It is recommended in this situation, being very complex, a practitioner would need a variety of motivational interviewing skills and have knowledge of cognitive behavioural therapy (American Dietetic Association, 2001). Alternatively, if a dietitian was to use a biomedical model of health many issues would be left untreated as only the problem of weight loss and malnutrition would be managed, when it is scientifically proven that many other emotional complexities play a pivotal role in eating disorders (ADA, 2001).
It could then be summarised then, that from a traditional point of view, using a biomedical model does not allow one to look to reduce mortality rates but rather partially contributes to improvements in healthcare together with other factors such as lifestyle, nutrition, emotions and sanitation. On the other hand by using a biopsychosocial model one can look at health promotion and primary prevention of illnesses and disease (Stroebe, 2000). The WHO (2005) offer ten major lifestyle contributors to over half of the world’s deaths these include, smoking, high cholesterol, high blood pressure, alcohol and obesity. Consequently by using a biopsychosocial model of health a dietitian can highlight contributors of ill-health for a patient at high risk of developing complications or disease. The Dietitian is in a position to help the patient reduce this risk and gain control of their own health, i.e. self-efficacy, through behaviour change techniques.
From the literature it is evident to see that using a biopsychosocial model of healthcare incorporates the philosophies of a biomedical model however, the former has wider appeal in that it examines more than biological factors associated with illness and disease. By using a biopsychosocial model one would expect to, highlight areas in healthcare that need to improve, identify places where health promotion needs to be established, and establish the best patient care possible. Although it is not possible to completely neglect the biomedical model, after all, it did lead theorists to further studies and help our healthcare system find cures for specific diseases in the early centuries. However as time goes by research improves and with that healthcare should improve.
As a result of all these findings, one can then conclude that a biopsychosocial model of health would be better suited to Dietetic practice. This approach allows one to reflect on individual patients and their needs, and also emphasises Dietitians responsibilities as healthcare professionals to provide holistic evidence based care.
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