Special articleThe end of the disease era
Section snippets
The problem
Chronic dizziness remains unrelieved; psychological contributors to cardiovascular disease are ignored; 75-year-old patients consume an average of 15 medication doses each day; patients leave the hospital with their pneumonia cured but their cognitive and physical functioning irreversibly impaired. The diagnosis in each of these cases is a primary focus of medical care on disease.
The time has come to abandon disease as the primary focus of medical care. When disease became the focus of Western
A solution
The obvious solution is to better align medical care with health needs by integrating existing knowledge and effective strategies. Rather than waiting until the disease model fails to invoke alternative strategies, the integration and coordination of such strategies should constitute the standard of care for all patients. Clinical decision making should be predicated on the attainment of patient goals and on the identification and treatment of modifiable biological and nonbiological factors,
Challenges and barriers
Attempts to develop a more integrated and individualized model will be met with structural and philosophical barriers. To accomplish its goals, health care must become more interdisciplinary. The lack of coordination, or even communication, among relevant disciplines could worsen the already egregious fragmentation of health care. The increased emphasis on psychological, so-cial, environmental, and other factors will raise concerns about the “medicalization” of life problems (39). Although
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