Holistic Versus Biomedical Model

Biomedical Model

1. Doctor makes diagnosis and decides treatment strategy. Patient follows dIrections. Doctor provides a service.

2. Cause and effect link is linear. "You got sick because..." Treatment options are limited and by protocol.

3. Patient classified by disease cate­gory-treatment directed toward the disease process.

4. Goal of treatment Is removal of dis­ease. This may be technology intensive. End point set by doctor. Acceptable risk for Dr., low--for patient, high.

5. Diagnosis is based on breaking the problem down into parts (i.e., "We'll fix your kidney, then you'll be fine.")

6. Outcome of treatment based on the quality of medical "fix," probability of success not based on factors unique to the patient (e.g., double blind studies comparing one medication to another).

7. Medical approach based on diagnosis, technology intensive. Diagnosis is static. Often, no change is expected to occur over time. "You have diabetes. You will be on medication for the rest of your life."

Holistic Model

1. Doctor provides information and op­tions for treatment; patient makes in­formed decisions about the course of treatment. Dr. and patient have a part­nership type of relationship with shared descision making.

2. Illness comes about as a result of multiple factors and circumstances. Treatment options broad, multiple mod­els considered (e.g., nutrition, environ­mental factors, lifestyle decisions).

3. Patient's uniqueness recognized. Treatment directed toward the person.

4. Goal of treatment based on patient's value system. End point reached by consensus.

5. Interaction of bodily systems and role of emotions, personality, and faith In­cluded in consideration of diagnosis and treatment. "Stress increases blood sugar and blood pressure."

6. Patient is given credit for outcome of process, e.g., the woman delivered the baby, not the doctor. Role of patient's involvement given more credence.

7. Role of hope recognized. Example: Connection between mental attitude and connection to community/support group shown to increase effectiveness of treatment, lengthen survival, decreased need for medication.

Issues in Question

1. What Is the role of the patient in the doctor-patient relationship? What Is the role of the doctor?

2. What is the community's perception of how illness develops, the basis of disease?

3. What is the doctor's perception of the problem and his/her orientation toward treatment?

4. Who Is responsible for evaluating information and making decisions?

5. How can we best understand the nature of sickness and health?

6. Who possesses power in the arena of health and illness? What significance Is placed on the actions of the doctor and the patient?

7. What Is the perception of what the person can expect to happen over time? How predictable Is the outcome of an illness?