Biomedical models and healthcare systems: Developmental perspective may elucidate argument

doi:10.1136/bmj.330.7488.419-a

BMJ 2005;330:419 (19 February), doi:10.1136/bmj.330.7488.419-a

Letter

Biomedical models and healthcare systems

Developmental perspective may elucidate argument

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

EDITOR—Wade and Halligan asked whether biomedical modelsof illness make for good healthcare systems.¹ Alternative understandingof signs and symptoms can make for better healthcare systems.Signs relate to disease, symptoms to illness experience. AdaptingTinbergen's ethological quest for understanding behaviour tounderstanding illness behaviour points to four questions:

Why is the behaviour shown now?
How did the person grow torespond 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 personlearns to present symptoms so that they achieve greatest survivalvalue answers the second and third questions.

Symptoms are shaped depending on their communicative and survivalvalue. Symptoms, as constituents of a language of illness, dependon an ability to take into account how others see them. Similarlymedical practice becomes "mindful" medicine when it is awareof how . . . [Full text of this article]

Simon R Wilkinson, child and adolescent psychiatrist

Sogn Centre for Child and Adolescent Psychiatry, 0319 Oslo, Norway Simon.wilkinson@c2i.net

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