Towards regeneration: the evolution of medicine from fighting to buildingBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1586 (Published 17 April 2018) Cite this as: BMJ 2018;361:k1586
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On last electronic bmj issue powerfully have called me the attention the essay entitled: “Towards regeneration: the evolution of medicine from fighting to building”, written by Dr. Ian G Hargraves and colleagues and published on April 17th. My first impression after reading that title was such that I have thought that authors wanted to make emphasis on medical education, for proposing new challenges, a new dynamics oriented towards the training of a student with a profile more oriented towards prevention and health promotion (Building) than in the traditional formation, whose main goal is to prepare him for medical care of patients in health dispensaries, clinics, or hospitals as it has been until now (fighting). Anyway, nowadays, on health sector we are living similar situations to those that our country is experiencing, with the so-called peace process. After many years, our political leaders became to the conclusion that it’s better, less expensive and healthier to dialogue and discuss with groups outside the law for trying to solve the critical problems that afflict our society, than to continue fighting them by means of strongly armed groups. Combat, fighting by the traditional methodology, diabetes, hypertension, cancer, or other chronic condition costs a lot of money and the results of this struggle little contributes to solve those very serious problems, by the contrary that helps to increase the problem. In theory, it’s much better to promote a social and educational dynamics directed towards prevention of such diseases and health promotion. It’s necessary to make a stop on the way and rethink what we are doing. Health services around the world don’t want to invest in the traditional, macroscopic and palliative care for patients with chronic diseases, because every year they invest more and more in that sector, and the problems continue yet. In addition, in all countries, in the last 15 years, has been a significant increase in annual budget for that sector, accompanied by a significant increase in prevalence of chronic diseases. Living forces that manage health care make a lot of emphasis on building and maintaining health, however in Latin-American countries is very complicated to make prevention and promotion. The main reason is: the states don’t want to engage in the basics, which consist in creating a social security system that ensures daily people’s life, as that is not economically profitable for our leaders, from the financial point of view; it has not been put in practice. In addition, there are some cultural patterns introduced in practice several years ago, which are very difficult to eradicate and that seriously affect the people´s health. These difficulties are closely related to the characteristics of our traditional, outdated, and unproductive educational system.
In medical curriculum committee meetings, here at Surcolombiana University, we always discuss about what should be the true professional profile of the Colombian physician, what should be his social role. The big question is, what is more important for our society, a very skilled doctor who daily interrogates, evaluates patients, diagnoses, and fights against disease by treating it according to previously evaluated and established medical protocols, or, by the contrary, a professional who serves the community in aspects related to disease prevention and health promotion. After many years of discussion, the controversy still continues; but taking into account that daily wages of workers are very low, I think that in these countries we cannot make good disease prevention, mainly because poor families don’t have the necessary money for living according with natural requirements; people don’t have a good nutrition system and their lifestyle is very bad; furthermore, there is not a social security system, that guarantee the people’s life, nor a good training school for well educating pupils and students in prevention and promotion. So, in these countries, for a long time fighting will be more important than building.
Competing interests: No competing interests
An interesting article, however, in the authors' case study when comparing scenario one and scenario two, I cannot help but feel scenario two is just an example of good biopsychosocial care. If this is the case, why is there need for a new label (or the extension of an already existing label) for something that is not novel? I think readers may benefit from the authors discussing this and the difference between the biopsychosocial model and their proposed broader meaning of regenerative medicine.
Competing interests: No competing interests