Medical model is the synthesis of basic concepts, conceptual framework, mode of thinking and development norms of medical development in a certain historical period, which mainly reflects what viewpoints and methods people use to study and deal with medical problems at all levels. It is the basic idea and main method to observe and deal with related problems in the medical field gradually formed in the process of medical practice, and its core is medical view.
Medical model includes medical cognitive model and medical behavior model, the former refers to people's understanding of medicine itself in a certain historical period, that is, medical epistemology; The latter refers to the behavior paradigm of people's medical practice activities in a certain historical period, that is, medical methodology.
First, the characteristics and functions of medical model
The evolution of medical model is the natural law and inevitable process of social and medical development. Different stages of medical models have their own characteristics, which affect medical thinking and action.
(A) the * * characteristics of medical model
The emergence of medical model is social, its existence is universal, its influence is extensive and its development is dynamic.
1. Sociality of medical model
Medical model is produced under the social background, and its emergence and evolution are the products of the development of natural science and social science, which is closely related to the development of society. The progress of human civilization is synchronized with the continuous development and innovation of human world outlook, methodology and science and technology. The evolution of medical model is the natural law and inevitable process of social and medical development.
2. The universality of medical model.
Medical model is a subjective reflection of objective things and an objective philosophical concept. Medical model widely exists in medical practice, so it is objective and universal, which is characterized by being independent of human will, and the concepts of health and disease are generally rooted in people's thoughts.
3. The universality of the influence of medical model
Theory guides practice and has a wide influence on practice. Medical model is a high understanding of medicine and a historical summary of medicine, that is, a systematic medical theory, which has a far-reaching impact on behaviors related to medical practice.
The extensive influence of medical model is reflected in modern medical model, which plays an important guiding role in the theoretical and practical work in medical science and health fields, making modern medicine show a two-way development trend of "high integration" and "high differentiation".
4. Dynamic development of medical model.
The medical model is dynamic and gradual, not static. The gradual development of this medical model conforms to the natural laws of social and medical development. The constant change of social productive forces, the change of political and cultural background, the development of science and technology and the progress of philosophical thought are the driving forces for the transformation and evolution of medical model. The new medical model is a new leap and breakthrough when the old medical model develops to a certain extent, and it is a process of continuous sublation and sublimation, that is, it constantly evolves in the circular model of "medical practice-medical model establishment-medical practice-new medical model establishment".
(B) the role of medical model
Medical model can also be regarded as the application of modeling principles of scientific research in medicine. It is not only the result of people's understanding of medicine, but also represents a medical research method. Medical model is produced in medical practice, which shows people's views on health and diseases in a highly abstract and generalized way, and also reflects the relationship and essence of the overall structure of medicine in a specific period, reflecting the fields, methods and objectives of medical research.
All medical scientific research and medical activities are carried out under the guidance of certain medical concepts and epistemology, so they are also carried out under certain medical models. Medical model is formed in practice, which affects people's medical views in the form of ideas, and then affects people's medical thinking and medical actions.
Second, the evolution of medical model
Medical model, as a natural view and methodology with medicine as the object of observation and research, is adapted to a certain social and historical background, a certain level of science and technology and the overall level of philosophy. A certain medical model is relatively stable in a certain period of time, but the change of social and historical background, the progress of human science and technology and the overall improvement of philosophical level will inevitably bring about the replacement of medical models. The transformation of medical model is not a simple substitution process, but a process from quantitative change to qualitative change, constantly surpassing, perfecting and sublimating.
In addition, after the new medical model comes into effect, the old medical model will not disappear or lose its function immediately, and it will still have certain influence in some medical fields.
Every stage of medical development has a corresponding medical model, which reflects the medical development status and level of that period. Medicine has gone through different development stages of ancient medicine, modern medicine and modern medicine, and the medical model has also gone through deism, natural philosophy, mechanism, biomedicine and biopsychosocial medicine.
This gradual evolution conforms to the general laws of medicine. With the deepening of human understanding of the essence of medicine, there will inevitably be a new health care model that is more in line with the needs of scientific development and more suitable for modern human health care. Therefore, the evolution of medical model is continuous, constantly improving and endless.
(A) Spiritualism medical model (Spiritualism medical model)
Since ancient times, due to the limited understanding of diseases, the ancients believed that life and health were given by God, and diseases and disasters were the punishment of God or evil spirits. And death is the time when the gods recall their souls; The treatment of the disease depends on exorcising the plague, and restoring health by offering sacrifices to heaven or "jumping" to exorcise demons and pray. Thus formed the early concept of health and disease, that is, there are supernatural gods in the world who dominate human health and disease.
Under the influence of this thought, people mainly rely on God's advice and forgiveness, and use witch doctors to exorcise evil spirits to preserve health and treat diseases. So witch doctors at that time often made a living by pleasing patients. It is more important to please patients with some so-called witchcraft than to confront diseases head-on. Mr Trudeau's phrase "always comforting" is a true portrayal of this period, or a kind of helplessness, reflecting the mentality of that era.
The medical model of deism is produced under the background that scientific thinking has not yet been established, productivity is extremely low and supernatural forces are extremely worshipped. Explaining human health and diseases with supernatural power is the embodiment of backward productivity and low scientific and technological level in the early stage of human beings, and reflects primitive religious thoughts and idealistic philosophy. This model should be abandoned.
(b) Natural philosophy medical model.
With the progress of human society and the in-depth understanding of nature, people began to get rid of the shackles of religion, have a more rational and objective understanding of natural phenomena, and began to try to explain diseases with natural substances and phenomena. During this period, people advocated the harmony between man and nature, consciously linked diseases with nature and social environment, and gradually formed a relatively simple and dialectical natural philosophy medical model.
Understanding, observing and thinking about health and disease with the objective existence and development law of natural phenomena is the initial transformation of human beings from idealism to materialism. Among them, the most representative is the theory of four body fluids put forward by Hippocrates, the father of medicine in ancient Greece, and the theory of yin-yang and five elements in traditional Chinese medicine.
The medical model of natural philosophy has got rid of the bondage of supernatural forces with mysterious functions. People began to explain life, health and disease with intuitive material factors such as "four body fluids" and "yin and yang and five elements", and drove the ghost of atheism out of medicine with the power of atheism, which is the historical progress of medical model. Based on this medical model, the systematic theoretical system of ancient medicine in China and Arabic medicine rising in Central Asia came into being.
However, the medical model of natural philosophy, like natural philosophy, is limited by empirical philosophy and the level of science and technology. It is based on intuition and sometimes relies on ideological speculation to make up for the lack of observation, so it has certain defects and will inevitably be replaced by advanced medical models.
(3) mechanistic medical model.
/kloc-In the second half of the 0/5th century, the Renaissance in Europe promoted social change and productivity development. Machine production replaced manual production, and people gradually got rid of the shackles of religious theology and turned to mechanical determinism. Therefore, the experimental philosophy led by mechanical determinism came into being, and the mechanistic medical model was gradually formed. Representative figures are French philosopher and scientist R.Descartes (1596- 1650) and French doctor Lametti.
Descartes put forward in the book Animals and Machinery that animals and human bodies are precision machines with various functions, and all physiological functions can be interpreted as the movement of material particles and the thermal movement generated by the heart. He compared the heart to a heater. Compare the lungs to a cooler, compare the movements of nerves, muscles and tendons to warnings and clockwork, and explain the functions of the human body with mechanical principles.
Lametti published the book "Man is a Machine", arguing that "when the human body starts its own machine, the disease is the fault of a certain part of the machine, which needs to be repaired and improved". Since then, human exploration of medicine has entered the era of experimental science and mechanical theory, forming a modern metaphysical mechanical materialist view of nature that explains all natural phenomena with "force" and mechanical movement.
The mechanistic medical model urges people to observe the human body and explain diseases from the point of view of matter and movement, breaks through the limitations of religious theology and idealism philosophy, leads medicine from empirical medicine to the era of experimental medicine, and applies experimental methods to the medical field, which promotes the rapid development of anatomy, physiology, pathology and surgery and has a far-reaching impact on modern medicine. However, it also has some limitations. People often use the mechanistic view to explain all human phenomena, but ignore the biological, social and psychological complexity of human beings.
Biomedical model (biomedical model)
From the second half of18th century to19th century. /kloc-three epoch-making discoveries in the 0/9th century-the law of conservation and transformation of energy, the theory of biological evolution and the theory of cells-greatly shook the foundation of mechanical materialism. At the same time, immunology, pathology, biochemistry, histology and embryology, molecular biology and other life sciences have come out one after another, providing necessary technical support and scientific basis for solving major problems in the medical field, and promoting the process of the whole medicine from empirical medicine and experimental medicine to modern medicine.
As a result, people have a more scientific understanding of physical changes and life phenomena, as well as health and disease, so a modern biomedical model based on biomedicine was born.
Biomedical model pursues causality and uses the logic of "observation, hypothesis, verification and conclusion" to explain, diagnose, treat and prevent diseases. Any disease is a disorder of biological mechanism, and cavitation with specific morphology, structure and biological indicators can be found in organs, cells and biological macromolecules. The purpose of medicine is to measure these changes through precise technology, explain the symptoms and signs of patients and take corresponding treatment measures.
Especially with the continuous breakthrough of genetic research, medical scientists mistakenly think that they have found the golden key to finally conquer diseases, and the medical community has fallen into unprecedented blind self-confidence.
Many people think that it seems that all diseases can be conquered, and doctors have enough ability and authority to challenge diseases, including overcoming aging, conquering cancer and refusing to die. With the expansion of technology, the medical profession has greatly neglected the medical humanities work. In the eyes of many doctors, there are only diseases, no patients, only technology and no comfort.
The biggest contribution of biomedical model to medicine lies in disease control and disease prevention. The application of disinfection and sterilization in surgery has obviously reduced the postoperative infection rate. The invention and application of anesthetic solved the pain problem; The advent of antibacterial drugs has effectively controlled infection; People have defeated acute infectious diseases and parasitic diseases with three magic weapons: sterilization, vaccine and antibacterial drugs.
In addition, the biomedical model has promoted the all-round and multi-field development of biomedical science, and formed a medical network system with a large number of disciplines that are deeply and horizontally interrelated and infiltrated. By the middle of the 20th century, a huge discipline system with more than 50 categories and hundreds of branches with molecular biology as the core has been formed.
Biomedical model has made great contributions to human beings, but with the development of society, people's requirements are getting higher and higher, and the limitations of biomedical model are becoming increasingly prominent. First of all, people's biological attributes are overemphasized, and only biomedical diagnosis and treatment are emphasized, without considering the influence of psychological and accounting factors on the occurrence, development and prognosis of diseases. Secondly, the structure and function of human body and pathological changes of diseases are studied through decomposition and reduction.
Only pay attention to the local and ignore the whole, dismember human diseases into organ diseases, and ignore the social environment and psychological factors of patients. Finally, studying the human body in a metaphysical way hinders the comprehensive understanding of the comprehensive factors affecting the internal changes of the human body, fails to care for and understand patients from an ethical point of view, and leads to the alienation and tension of the doctor-patient relationship.
(5) Bio-psychological-social medical model.
Since 1950s, the "spectrum of diseases" and "spectrum of causes of death" have changed greatly. Infectious diseases and parasitic diseases are no longer the main diseases threatening human health, while heart diseases, malignant tumors and cerebrovascular diseases occupy the top three causes of death. With the development of globalization and urbanization, environmental pollution, psychological stress, smoking, alcoholism and other risk factors are widely exposed, and the incidence of chronic non-communicable diseases (referred to as "chronic diseases") has risen sharply.
Therefore, the biomedical model that only pays attention to biological factors can no longer solve the problems of human health and disease, and it is necessary to consider the influence of biological, psychological and social comprehensive factors on people's body and mind. The bio-psycho-social medical model was formally put forward by G.L.Engel, a professor of psychiatry and internal medicine at the University of Rochester, in the journal Science from 65438 to 0977.
"Bio-psychological-social medical model" holds that people's health and diseases depend on biological, psychological, social and other factors. To maintain and promote human health, efforts should be made from people's living environment, behavior, spirit and health services. Bio-psychological-social medical model is a medical model to understand human health and diseases from biological, psychological and social aspects. It is a multi-cause, multi-effect and three-dimensional network medical model based on biomedical model.
It requires that people be regarded as a whole with biological and socio-cultural attributes, and that people and their natural and social environment be regarded as a whole. It requires that diseases, patients and health care system be analyzed as a subsystem of social system. It understands the causes of health and disease from multiple angles, and explores the means of disease treatment and disease prevention from multiple angles. That is, it has the characteristics of integrity, systematicness and pluralism.
Modern medical model does not deny the role of biological factors in the occurrence and development of diseases, nor does it deny the significance of physiological and biochemical indicators in disease diagnosis, but only emphasizes its role and significance at a higher level. Biological factors, psychological factors and social factors all restrict human health and diseases. Diseases are not only caused by biological factors, but also by social and psychological factors. People should be regarded as a unified whole, and more attention should be paid to the pathogenic role and influence of psychological and social factors in the process of disease prevention and rehabilitation.
Although biological factors are still the core of modern medical model, psychological factors and social factors should occupy a more important position in medical behavior and attract more attention to meet people's growing health needs with the improvement of living conditions.
The bio-psychological-social medical model liberates human medical thinking mode from the traditional biomedical thinking mode, and promotes human beings to explore life phenomena in a multi-level, multi-faceted and three-dimensional way with a comprehensive and systematic thinking mode, master the changing law of diseases and correctly handle medical problems.
In addition, it expands the research scope of modern medicine, organically combines social science with natural science, and urges people to study and solve medical problems from the perspective of social and psychological factors; It enriches the connotation of preventive medicine and promotes the development of public health. It is not only of great significance to the analysis, diagnosis and treatment of diseases, but also plays a very important guiding role in disease prevention and control and health promotion.
Bio-psychological-social medical model is a medical model that is more in line with materialist dialectics so far. However, with the progress of human society, the development of medical science and the continuous improvement of people's cognitive ability, this model still needs to be improved, perfected and even updated.