The Persistence of the Medical Model
Wisdom is indemonstrable, art uncertain, strength powerless, wealth useless and speech impotent if health be absent.
Greek Anatomist Herophilus, the Father of Anatomy
A stunning moment in human history occurred in the 3rd century BC. Two men, who were curious about what caused the pulse, were given permission to dissect the first human cadaver on a condemned criminal. There was fierce opposition to human dissection. This was due to many reasons, mostly fear that the soul of the cadaver, once cut open, would not make it to the afterlife and wreak havoc on the community. In order to not interfere with the cadaver’s soul, the anatomists were instructed to not involve themselves with the soul, drape the body and expose only the body part being dissected. This early separation of body and soul, the physical from the emotional, gave birth to the medical model which still persists today. The medical model assumes a mechanical view of illness, a fault in the machine. This early separation of body and mind has led to remarkable innovations, yet when we silo body parts, we miss the mark. A lot.
I recently witnessed this firsthand with a relative after a knee replacement. While all of the procedures were followed and she received great care, there was nobody looking at the whole, looking at the person, the emotional landscape and what she needed. I could see her ‘patient’ needs going unmet day after day. What my loved-one needed was autonomy and she was nearly yelled at and given little to no choice. About anything.
When you experience a health care encounter and don’t get what you need or aren’t made more whole, perhaps you are running into the limitations of the medical model and are in need of a wider lens, a more integrative approach. If you have a chronic symptom (or unsustainable stress levels, loneliness, etc) which can be modified with how you live, you may want to explore the unseen emotional conflict within yourself. Excavate your needs, re-integrate your body and soul, look at the whole arc of your life and don’t rely solely on the medical model for answers.
Science is organized knowledge, wisdom is organized life.
Your blog resonated with me! I hope nurse practitioners consider body and mind in every patient encounter. I would also like to think we are inherently holistic in our perspective. However, this may not always be the case as we are forced to work faster and see more patients in less time. Without realizing it we may be defaulting to the medical model in order to survive day to day.
Thank you Mimi- yes we have a different and broader view but many of us are working in the narrow context of treating symptoms or body parts. The system cant allow for us to fully deploy a wider approach to patient care. As Loretta Ford says, parts of the health care system are “sclerotic and ossified”, but I see pockets of hope! Smiles, EIleen
I just experienced a similar situation. A friend was in the emergency room five times in 30 days. Two resulted in admissions. Always the same problem – nausea, vomiting, severe belly pain, unable to eat and getting weaker. She had every test and was told they could not find anything wrong. This couple has some memory loss and the elderly answer slower, which frustrated the emergency room staff.
During the first 30 days, she was told to not eat so much, try to walk more, eat low fiber, eat high fiber, avoid milk products, etc. No one listened to what this lady was saying. At one point someone said “are you back again”. At this couple aged, they did what the doctor said to do without question. Finally, The family asked for help. Had she not gone to another hospital and had emergency surgery, she would have died. The emergency room people looked at this lady as an elderly lady with constipation. What they missed was a very sick lady with a unique congenital abnormality that caused strangulation of the bowel and near rupture.
What we have to remember is even our chronic complainers and our frequent flyers sometimes really are sick. Look at the whole person. We often think the frequent users of health care as lonely or sad and looking for friends. But listen to what they are saying. I remember in nurse practioner school as I was following doctors, people would complain of vague abdominal pain. The doctor would order xrays, pain meds, etc. I would ask how life has been lately – and most of the time, there was a loss of some kind – a death, a divorce, kids moving away. Lonliness, sadness, depression. I know we need to check out the physical symptoms, but remember the emotional side.
Hi PAm- You are so right, the nursing lens is far broader- Flo Nightingale had the vision to look at the whole and the environment and sometimes very simple things make a huge difference. Much of what we see in the chronic illness realm is self defeating behavior, but your friend had a life threatening mechanical problem that was missed. Yikes. Nice to hear from you. Eileen
As a career physician, I’ve become accustomed to that perfunctory method of “silo-ing” fragments of the human frame when performing medical procedures. And to be frank, your clear analysis of the problem explained it exhaustively. Hit it right on the head. I feel lugubrious when I do that to unknowing patients who either aren’t aware or aren’t capable of realizing their body’s biological and metaphysical interconnectedness on an existential level. What a halcyon moment I experienced reading this post. Cheers.
Thank you Peter. there seems to be some movement and demand for more integration. Its great to have physicians like you who see the need for connections. In the work I do, it seems that whats driving the chronic illness epidemic is this over-medicalized notion that the health care system can fix it, when in fact its what the person does, thinks and believes between the office visit or hospitalization on a daily basis. Those beliefs and actions seems to be the driver. Wonderful to hear from you.