www.nmgpsy.com内蒙古心理网The possibilities of patient-centered medicine*
ENID , B.Sc.
London
Case work consultant, Tavistock Institute of Human Relations, London; honorary secretary, TrainingCommittee, British Psycho-analytical Society
IN his paper, The Structure of the Training cum Research Seminar and its Implicationfor Medicine, Michael Balint spoke about two classes of pathological conditions:Class I comprises conditions in which a localizable 'illness' can be found. In this classscientific examinations can identify a fault either in the body or in one of the partfunctions in the body. In this way of thinking, the prime aim is to find a localizablefault, diagnose it as an illness and then treat it. This is what we call 'illness-orientatedmedicine.'
In contrast, there is another way of medical thinking which we call 'patient-centredmedicine'. Here, in addition to trying to discover a localizable illness or illnesses, thedoctor also has to examine the whole person in order to form what we call an 'overalldiagnosis'. This should include everything that the doctor knows and understandsabout his patient; the patient, in fact, has to be understood as a unique human-being.The illness which can be described in terms of a 'traditional diagnosis' is either anincident like a broken leg, or a part like accident proneness which makes better senseif understood in terms of the whole.
The question which has recently been occupying our minds is: How does a practisingdoctor avoid a split in himself? How can he avoid being a general practitioner to someof his patients and a competent psychotherapist to others? Or, expressed in our newterminology: How can he avoid practising 'illness-orientated medicine' with some patientsand 'patient-orientated medicine' with others.
Before proceeding it is necessary to state the problem in a slightly different way:What was our aim when, in 1950, we started advertising in the medical press in Londonthat we proposed to hold seminars on the psychological problems in general practice?Did we, in fact, have in mind to teach our doctors to be minor psychotherapists? Didwe aim in establishing this sort of split?
If this were so, why are we so worried about it now, because clearly if this had beenour aim, we could not have expected our doctors to remain whole doctors with oneprofessional activity as they were bound, it would seem, to do 'psychotherapy' withsome patients and 'general practice' with others. Leaving on one side their patients,requirements, the size of their practices alone would not permit them to do minorpsychotherapy with all their patients. Furthermore, if they wished to become psychotherapists they could take the necessary training and leave general practice altogether.
ENID , B.Sc.
London
Case work consultant, Tavistock Institute of Human Relations, London; honorary secretary, TrainingCommittee, British Psycho-analytical Society
IN his paper, The Structure of the Training cum Research Seminar and its Implicationfor Medicine, Michael Balint spoke about two classes of pathological conditions:Class I comprises conditions in which a localizable 'illness' can be found. In this classscientific examinations can identify a fault either in the body or in one of the partfunctions in the body. In this way of thinking, the prime aim is to find a localizablefault, diagnose it as an illness and then treat it. This is what we call 'illness-orientatedmedicine.'
In contrast, there is another way of medical thinking which we call 'patient-centredmedicine'. Here, in addition to trying to discover a localizable illness or illnesses, thedoctor also has to examine the whole person in order to form what we call an 'overalldiagnosis'. This should include everything that the doctor knows and understandsabout his patient; the patient, in fact, has to be understood as a unique human-being.The illness which can be described in terms of a 'traditional diagnosis' is either anincident like a broken leg, or a part like accident proneness which makes better senseif understood in terms of the whole.
The question which has recently been occupying our minds is: How does a practisingdoctor avoid a split in himself? How can he avoid being a general practitioner to someof his patients and a competent psychotherapist to others? Or, expressed in our newterminology: How can he avoid practising 'illness-orientated medicine' with some patientsand 'patient-orientated medicine' with others.
Before proceeding it is necessary to state the problem in a slightly different way:What was our aim when, in 1950, we started advertising in the medical press in Londonthat we proposed to hold seminars on the psychological problems in general practice?Did we, in fact, have in mind to teach our doctors to be minor psychotherapists? Didwe aim in establishing this sort of split?
If this were so, why are we so worried about it now, because clearly if this had beenour aim, we could not have expected our doctors to remain whole doctors with oneprofessional activity as they were bound, it would seem, to do 'psychotherapy' withsome patients and 'general practice' with others. Leaving on one side their patients,requirements, the size of their practices alone would not permit them to do minorpsychotherapy with all their patients. Furthermore, if they wished to become psychotherapists they could take the necessary training and leave general practice altogether.
