Evolution of Medical Practice and Introduction to Medical Humanities

Learning outcomes

At the end of this lecture you will be able to:

• Explain the recent changes in medical practice 


• Explain the differences between Biomedical and Biopsychosocial models of medicine 


• Explain the need for more humanistic medical care 


• Define Medical Humanities




Medical humanities :

• Concerned with “the science of the human”

• Brings the perspectives of disciplines such as history, philosophy, literature, art and music to
understanding health, illness and medicine.

Medicine in the 20th century :

• More mechanical and less human.

• Advances in diagnostic technology have helped shift medicine towards an increased focus on
physical abnormalities – rather than on the patients’ symptoms, their psychological state, or their
social and cultural background.

Medicine in the 21st century :

• Hyper-specialization

• Medicalization of daily life

Hyper-specialization

• Many doctors now diagnose and treat abnormalities of only a small part of the human body
(hyper-specialists).

• Their professional aim is, in a sense, to know more and more about less and less.

• (and often this results in knowing less and less about more and more)

• In modern medicine, hyper-specialists end to have a higher status and a higher income than
many generalists, such as general practitioners.
• In addition, those specialists, who are publicly seen to ‘cure’, have a higher status than those
who merely ‘care’.
 Medicalization of daily life

Ivan Illich - Austrian philosopher (1926-2002)

• The medicalization of life (1975)

• Medical Nemesis (1976)

Thomas S. Szasz Hungarian-American psychiatrist (1920-2012)

• The Medicalization of Everyday Life (2007)

• The Myth of Mental Illness (1974)

Michel Foucault French philosopher (1926-1984)

• The Birth of the Clinic

• The focus of medical practice shifted

- from the home visit (with its bias towards the patient and family and its restrictions on the
doctor as guest in another’s house)

- to the patient attending a clinic (with its bias towards the clinician and its restrictions on the
patient as a visitor to the hospital)

Medical work :

• Medical work can be understood as a set of practices (such as listening, asking questions,
diagnosing, or recommending treatments) undertaken by doctors to help those who seek
medical attention.

• At the core of such medical work is the definition of ‘disease’ and ‘illness’, two terms rooted in
different understandings of people’s ‘ill health’.

Biomedical Model :

• Historically dominant model of western medicine is Biomedical Model.

• Biomedical model assumes disease to be fully accounted for by deviations from the norm of
measurable biological (somatic) variables. 


Paradox of the Biomedical model :

• Some people with positive laboratory findings are told that they are in need of treatment when in
fact they are feeling quite well, while others feeling ill are assured that they are well.

New model: Biopsychosocial model :

• Patients would continue to be cared for from a disease standpoint but, additionally,
psychological and social information would be given equal standing in the care process.

Medical models :

• Although it is now international, there are enormous variations in how Western medicine is
practiced in different parts of the world.

• This applies in different Western industrialized countries, and even within those countries
themselves.

• The medical model is always to a large extent culture-bound, and varies greatly, depending on
the context in which it appears.

• Even within the same society, huge differences in perspective exist between different branches
of medicine and the different specialties.

• Any physician or medical discipline has a repertoire of interpretative models – biochemical,

immunological, viral, genetic, environmental, psychodynamic, sociologic and so on, each with
its own unique perspective on the disease.

• All medical models tend to change over time as new concepts are developed and new
discoveries are made.

Medicine as a system of morality :

• With the decline in organized religion in many Western societies, the moral concerns of the
contemporary age are increasingly being expressed in medical rather than religious terms.

• In a more secularized age, religious ideas of sin or immorality often seem to be replaced by
ideas of health and disease.

• Today, medical metaphors have become part of the daily discourse, for example a ‘sick society’,
an ‘epidemic of crime’, an ‘ailing economy’, ‘the plague of terrorism’.

• Whereas a few generations ago religion spoke out against a ‘sinful life’, medicine now
condemns the ‘unhealthy lifestyle’, but the punishments occur in this world, rather than in the
world to come.

Medical Humanities :

• A field of academic inquiry.


• The intersection of medicine and the creative arts.

• Creating“more compassionate ,more capably communicative doctors” that may “lead to better
health outcomes for patients”

• Emphasis on the importance of the biological sciences in early medical education lead to a bias
towards curative rather than caring medicine, where basic science teachers rather than
clinicians have a formative influence on students.

Humanistic medical care :

• Humanistic medical care is not simply compassion. It is the best of medicine.

• When skilled physicians build caring, trusting and collaborative relationships with patients,
studies reveal more appropriate medical decisions, better patient adherence with treatment
plans, and less costly healthcare outcomes.

http://medhum.med.nyu.edu : First medical humanities website was established by New York School of Medicine
in 1994.

www.hektoeninternational.org: Electronic medical humanities journal founded in 2009.

____________________________________________________________________________

Definition :

• Medical humanities is an interdisciplinary field of medicine which includes humanities (literature,

philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology,
sociology), and the arts (literature, theater, film, and visual arts) and their application to medical
education and practice.

• Disciplines that are often included under this category are history of medicine, bioethics, medical
epistemology and scientific research methodology, medical esthetics, medical pedagogy, medical
sociology, medical anthropology, economy of health, medical law, health politics, and medical
communication, among others. ( www.ea-journal.com )

Health Humanities :

• Medical humanities is mainly concerned with training medical practitioners.

• This contrasts with health humanities which more broadly links health and social care disciplines
with the arts and humanities.

Medical practice is evolving from,

• Physician-centeredness to person- centeredness

• Values to virtues

From Physician-Centeredness to Person-Centeredness

• Physician-centered healthcare

• Patient-centered healthcare

• Person-centered health care

From values to virtues

• Values are defined as preferred end points of questions asking people to justify what they care
about – to explain what makes them confident in their caring.

• Virtues are the values selected and refined as necessary for moral living. 


Changes in medical knowledge

• Half-life of medical knowledge is estimated to be 2-3 years and continuing to decrease.

Finally :

• Some studies estimate that new discoveries over the next 10 years will change more than
80% of what we know now, the methods we use for diagnosis and treatments, but most of all
will have an impact on prevention and lead to a radical rethinking of how we approach clinical
practice.

VeronesiU.etal.(2018)Myth#1:TheHealthcareSystemIsFailing.In:AdinolfiP., Borgonovi E. (eds) The Myths of Health

Care. Springer, Cham.
(Paola Adinolfi , Elio Borgonovi (Eds.). (2018) The Myths of Health Care: Towards New Models of Leadership
and Management in the Healthcare Sector. Cham, Switzerland.)