Do biomedical models of illness make for good healthcare systems?

doi:10.1136/bmj.329.7479.1398

BMJ 2004;329:1398-1401 (11 December), doi:10.1136/bmj.329.7479.1398

Education and debate

Do biomedical models of illness make for good healthcare systems?

Derick T Wade, professor of neurological rehabilitation¹, Peter W Halligan, professor of psychology²

¹ Oxford Centre for Enablement, Oxford OX3 7LD, ² Cardiff University, Cardiff CF10 3YG

Correspondence to: D T Wade derick.wade@dsl.pipex.com

Current medical models assume that all illness is secondaryto disease. Revision is needed to explain illnesses withoutdisease and improve organisation of health care

The first 150 words of the full text of this article appear below.

Introduction

Cultural and professional models of illness influence decisionson individual patients and delivery of health care. The biomedicalmodel of illness, which has dominated health care for the pastcentury, cannot fully explain many forms of illness. This failurestems partly from three assumptions: all illness has a singleunderlying cause, disease (pathology) is always the single cause,and removal or attenuation of the disease will result in a returnto health. Evidence exists that all three assumptions are wrong.We describe the problems with current models and describe anew model, derived from the World Health Organization's internationalclassification of functioning framework,^1
2 that provides amore comprehensive, less biologically dependent account of illness.

Importance of models for understanding illness

The model of illness adopted by society can have important consequences.In the first world war, for example, soldiers complaining ofsymptoms after experiencing severe stresses were sometimes shotas malingerers, but today they are considered . . . [Full text of this article]

Current models of illness

-->

Current problems

New model

Implications of new model

Conclusion

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Rethinking childhood depression: Does childhood depression exist?: D B Double
BMJ 2005 330: 418. [Extract] [Full Text] [PDF]

Biomedical models and healthcare systems: New model will be useful if it alters allocation of resources: Ellen S Wright
BMJ 2005 330: 419. [Extract] [Full Text]

Biomedical models and healthcare systems: Developmental perspective may elucidate argument: Simon R Wilkinson
BMJ 2005 330: 419. [Extract] [Full Text]

Biomedical models and healthcare systems: Tangible pathology has great validity: Peter Davies
BMJ 2005 330: 419-420. [Extract] [Full Text]

This article has been cited by other articles:

Wade, D. (2009). Generic or global outcome measures in rehabilitation: are they appropriate for measuring (and improving) service quality?. Clin Rehabil 23: 867-872
White, P., Smith, S. M., Hevey, D., O'Dowd, T. (2009). Understanding Type 2 Diabetes: Including the Family Member's Perspective. The Diabetes Educator 35: 810-817 [Abstract] [Full text]
Wade, D. T (2009). Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil 23: 291-295
Bowling, A., Seetai, S., Morris, R., Ebrahim, S. (2007). Quality of life among older people with poor functioning. The influence of perceived control over life. Age Ageing 36: 310-315 [Abstract] [Full text]
Wade, D. T, Halligan, P. W (2007). Social roles and long-term illness: is it time to rehabilitate convalescence?. Clin Rehabil 21: 291-298 [Abstract]
Lettinga, A. T, van Twillert, S., Poels, B. J., Postema, K. (2006). Distinguishing theories of dysfunction, treatment and care. Reflections on 'Describing rehabilitation interventions'. Clin Rehabil 20: 369-374 [Abstract]
Wade, D. (2006). Why physical medicine, physical disability and physical rehabilitation? We should abandon Cartesian dualism. Clin Rehabil 20: 185-190 [Abstract]
Wade, D. T (2005). Describing rehabilitation interventions. Clin Rehabil 19: 811-818 [Abstract]
Santana, V S (2005). Beyond the duality of disease and illness in occupational medicine. Occup. Environ. Med. 62: 284-285 [Full text]
Wade, D. (2005). 'But is the difference clinically significant?'. Clin Rehabil 19: 349-353 [Abstract]
Double, D B (2005). Rethinking childhood depression: Does childhood depression exist?. BMJ 330: 418-418 [Full text]
Wright, E. S (2005). Biomedical models and healthcare systems: New model will be useful if it alters allocation of resources. BMJ 330: 419-419 [Full text]
Wilkinson, S. R (2005). Biomedical models and healthcare systems: Developmental perspective may elucidate argument. BMJ 330: 419-419 [Full text]
Davies, P. (2005). Biomedical models and healthcare systems: Tangible pathology has great validity. BMJ 330: 419-420 [Full text]

Rapid Responses:

Read all Rapid Responses

Ideological bankruptcy: GH Hall
bmj.com, 14 Dec 2004 [Full text]
Deconstructing the illness metaphor: Philip J Barker
bmj.com, 15 Dec 2004 [Full text]
Re: Ideological bankruptcy: Michael Skelly
bmj.com, 16 Dec 2004 [Full text]
New model will be useful if it alters allocation of resources: Ellen S Wright
bmj.com, 16 Dec 2004 [Full text]
Re: New model will be useful if it alters allocation of resources: Michael Skelly
bmj.com, 20 Dec 2004 [Full text]
No model will serve all purposes: Deborah A Swinglehurst
bmj.com, 22 Dec 2004 [Full text]
The validity of tangible pathology: Peter Davies
bmj.com, 22 Dec 2004 [Full text]
Taking patients� explanations of illness into account: Dagmar M Haller, et al.
bmj.com, 23 Dec 2004 [Full text]
A developmental perspective to elucidate the argument: Simon R. Wilkinson
bmj.com, 28 Dec 2004 [Full text]
Detection of biopsychosocial health risks may improve health care systems: The INTERMED project.: Frits J Huyse, et al.
bmj.com, 25 Jan 2005 [Full text]