Biomedical models and healthcare systems
http://www.100md.com
《英国医生杂志》
EDITOR—Wade and Halligan asked whether biomedical models of illness make for good healthcare systems.1 Alternative understanding of signs and symptoms can make for better healthcare systems. Signs relate to disease, symptoms to illness experience. Adapting Tinbergen's ethological quest for understanding behaviour to understanding illness behaviour points to four questions:
Why is the behaviour shown now?
How did the person grow to respond this way?
What is the survival value of the behaviour?
How has the behaviour evolved phylogenetically?
The biomedical model has concentrated on the first. How a person learns to present symptoms so that they achieve greatest survival value answers the second and third questions.
Symptoms are shaped depending on their communicative and survival value. Symptoms, as constituents of a language of illness, depend on an ability to take into account how others see them. Similarly medical practice becomes "mindful" medicine when it is aware of how the patient has developed a theory about how their symptoms are likely to be responded to.
As I have argued elsewhere,2 children learn facts about disease and to allocate disease labels to their subjective illness experiences through parental attribution of sickness. Parents introduce them to an illness and disease vocabulary remembered in "semantic memory." Illness behaviour, evolving in parental care for children, becomes anchored in "implicit procedural memory," and so unavailable for recollection. The experience of symptoms of illness is remembered in patients' "episodic memory." Coherent integration of all memories can be surprisingly challenging.
Simon R Wilkinson, child and adolescent psychiatrist
Sogn Centre for Child and Adolescent Psychiatry, 0319 Oslo, Norway Simon.wilkinson@c2i.net
Competing interests: None declared.
References
Wade DT, Halligan PW. Do biomedical models make for good healthcare systems? BMJ 2004;329: 1398-401. (11 December.)
Wilkinson SR. Coping and complaining: attachment and the language of dis-ease. Brunner-Routledge: Hove, 2003.
Why is the behaviour shown now?
How did the person grow to respond this way?
What is the survival value of the behaviour?
How has the behaviour evolved phylogenetically?
The biomedical model has concentrated on the first. How a person learns to present symptoms so that they achieve greatest survival value answers the second and third questions.
Symptoms are shaped depending on their communicative and survival value. Symptoms, as constituents of a language of illness, depend on an ability to take into account how others see them. Similarly medical practice becomes "mindful" medicine when it is aware of how the patient has developed a theory about how their symptoms are likely to be responded to.
As I have argued elsewhere,2 children learn facts about disease and to allocate disease labels to their subjective illness experiences through parental attribution of sickness. Parents introduce them to an illness and disease vocabulary remembered in "semantic memory." Illness behaviour, evolving in parental care for children, becomes anchored in "implicit procedural memory," and so unavailable for recollection. The experience of symptoms of illness is remembered in patients' "episodic memory." Coherent integration of all memories can be surprisingly challenging.
Simon R Wilkinson, child and adolescent psychiatrist
Sogn Centre for Child and Adolescent Psychiatry, 0319 Oslo, Norway Simon.wilkinson@c2i.net
Competing interests: None declared.
References
Wade DT, Halligan PW. Do biomedical models make for good healthcare systems? BMJ 2004;329: 1398-401. (11 December.)
Wilkinson SR. Coping and complaining: attachment and the language of dis-ease. Brunner-Routledge: Hove, 2003.