??? ???? Medical model

1
??? ???? Medical model
??????? ???????
2
??Contents

• ??????????
• ??????????????
• ???????????????????

• Definition and evolution of medical model
• Bio-psycho-social medical model and its views of
  health
• Impact of bio-psycho-social medical model on
  medicine and society

3
????????????

• Concept and Evolution
• of medical model

4
1.???? ??Model in Social Medicine

• Initially, concept of mathematical logic
• Highly simplified theoretical thinking of the
  fundamental nature of medical practice
• Abstract model (or conceptual model)

• ?????????,????????????????????
• ???????????????????????????????
• ????????????

5
2. ???? Medical Model

• Naturalistic and Philosophical view and
  methodology. In line with the viewpoint and
  method of materialism and dialectics to observe,
  analysis and cope with the issues related to the
  health and diseases.
• The core of medical model is the viewpoint of
  medicine, it mainly deals with the attribute,
  function, structure and the law of medical
  development

• ??????????????,???????????????????????????????????
  ???
• ??????,???????????????????

6
The role of Medical model ?

• The soul of social medicine
• Guiding principle
• Theory as well as methodology towards Health and
  disease

7
????????? ( Spiritualism medical
model)????????? (Nature philosophical
medical model)???????? (Mechanistic medical
model)?????? (Biomedical model)
?????????? (Bio-psycho-social medical
model)?
3. ?????????Evolution of Medical Model
8
a.????????Spiritualism medical modelHow to look
at health and disease?

• Life and health is bestowed by the God
• Disease is caused by supernatural powers
• Once offend the gods, or disfavored by the gods ,
  disease is in the form of the punishment by the
  gods
• Possession of evil spirits, demons or monsters
  etc

• ?????????
• ??????????????
• ??????,?????????
• ??????????

9
Strategy1 drive the evil spirit away

• The natives of New Britain ascribe sickness,
  drought, the failure of crops, misfortunes, to
  the influence of wicked spirits.
• when many people sicken and die, the inhabitants
  of a district, armed with branches and clubs, go
  out by moonlight to the fields, where they beat
  and stamp on the ground with wild howls till
  morning, believing that this drives away the
  devils they rush through the village with
  burning torches.

10
Spiritualism medical model

• Treatment
• Pray to God and spirits for bless, forgiveness
  their protection
• Resort to natural plants or minerals for
  treatment, most is of emetic and cathartic
• Banish the spirits and ghosts that cause plague

• ????
• ?????????????
• ??????????????????
• ??????

11
b.?????????Naturalistic philosophical medical
????? ?????????

• THE FIVE elements the physical universe, can
  be reduced to five elementswood, fire, earth,
  metal, and water.
• Physical universe as divisible into two broad
  categories that were both opposite and
  complementary.
• The two poles of material phenomena were labeled,
  "Yin and Yang."

12
??????????What is the world made of?

• Chinese Philosophy
• Five Elements support and destroy each
  other,coordinate to each other
• Metal cutting, hard, conducting
• Wood growing, flexible, rooted, strong
• Water wet, cool, descending
• Fire dry, hot, ascending, moving
• Earth productive, fertile, potential for growth

• ????
• ???????????
• ?
• ?
• ?
• ?
• ?

13

• ???
• ???
• ????

14
????????TCM view of diseases

• Illness as an imbalance of two types of energy
  yin and yang which simultaneously exist in
  everyone and everything and within each other. 
• Yin represents the cold, slow, or passive
  principle,
• yang represents the hot, excited, or active
  principle.
• Health is a "balanced state" and that disease is
  due to an internal imbalance of yin and yang.

15

• ?????????

16
?????external causes of diseases

• The Causes of disharmony
• External Causes
• Six external evils
• wind,
• cold,
• heat
• damp,
• dryness,
• fire

• ?????
• ????
• ?
• ?
• ?
• ?
• ?
• ?

17
?????????--????Naturalistic philosophical
medical

• Hippocrates Airs, Waters, and Places , instead
  of ascribing diseases to divine origin, discusses
  their environmental causes.
• A town's weather, drinking water, and site along
  the paths of favorable winds can help a physician
  ascertain the general health of citizens.

• ?????lt???????gt
• ???????????????????

18
Naturalistic philosophical medical model

• Hippocrates ,founder of medicine. He based his
  medical practice on observations and on the study
  of the human body. He held the belief that
  illness had a physical and a rational
  explanation.
• He believed in the natural healing process of
  rest, a good diet, fresh air and cleanliness.
• The first physician believes that thoughts,
  ideas, and feelings come from the brain and not
  the heart

• ?????-??????

19
The role of Hippocrates on Modern Medicine

• Causes of disease could be internal, relating to
  faulty aspects of diet and exercise
• External factors relating to the forces of
  climate, winds, water and the seasons.

• ????--?????????????
• ???????????,???????

20
The role of Hippocrates on Modern Medicine

• ??????????--????????,????????????????
• ???????????????
• ?????????????????

• Hippocrates reject that diseases have a
  supernatural cause.
• first person to perceive a relationship
  between cause and effect in a mechanistic way
• Providing the foundation for modern scientific
  notions of disease causation.

21
??????Western theory of diseases

• all matter could be reduced
• to the basic elements
• earth, fire, air and water
• cold, hot, dry and wet
• four humour of phlegm, blood, black bile and
  yellow bile.
• Health----mutual balance
• Disease---disorder

• ??????? ???????
• ?????????
• ????????????????????
• ??????????????????????
• ??????????????????????

22
Humoural theory by Hippocrates

• Four bodily fluids phlegm, blood, yellow bile
  and black bile.
• Disease, in essence, becomes a state in which one
  of these four bodily fluids (humour) overpowers
  the others.

• ??????????????????
• ???????????????

23
Significance of Hippocrates

• The theory of humour is the first theory which
  attempts to integrate a natural theory of
  metaphysics with empirical first-hand
  observations of disease.
• It essentially marks the origin of the
  integration of Western medicine with early
  Greek naturalistic science . 
• The pathogenesis of disease is no longer
  mystical and inexplicable unnatural causes
  (demons, gods, etc.)

• ????????????????????
• ???????????????
• ???????--?????????????????

24
Significance of Hippocrates

• preceded to it a primarily mystical approach to
  disease which was characterized by the worship of
  gods, the fending off of evil demons
• it successfully separated Western medicine
  from--a primarily mystical approach to disease .
• marks the beginning of a rational pathophysiology
  

• ?????????????????????
• ???????????????????????????
• ??????????????

25
c.????????Mechanistic Medical Model

• Mechanistic view of the body
• Ill health is treated as the mechanical failure
  of some part of one or more of these
  interdependent systems and the medical task is
  to repair the damage.

26
??Background

• ???????
• ???????????????
• ???????????????????
• ?????????????

• A Shift in Ideas
• Growing acceptance of a developing scientific
  model.
• Development of research, observation, technology
• New ways of thinking about disease and the body.

27
????????Mechanistic Medical Model R. Descartes
???

• ??????
• ?????????????,??????????

• From the point of view of movement
• Human body is a machine with more parts, but not
  more alive, than any man-made automata, meaning a
  machine that moves itself.

28
????????Dualistic Interaction of Body and Mind

• To Descartes, man was a mind united with a body,
  the two interacting with each other.
• Mind and body are two separate things which makes
  the consideration dualistic.
• These two things or parts interact, and each
  affects the other.
• Medicine should pay more attention to body than
  its mind.

29
??????????

• Descartes Animal is Machine
• Lamterry Human is Machine, a machine start up
  itself
• Regard life activities as machine movement
• Protect health is just as the same way of
  protecting a machine
• Diseases in a state when machine breakdown and
  body out of order, therefore need to be repaired

• ????????gt
• ????????gt
• ???????????
• ????????????
• ????????????????
• ???????????
• ????????????????

30
d. Biomedical model

• ?????????????????,?????????????????????????,?????
  ??????,???????????
• ?????????????????,???????????????????????????????
  
• ???????????

• Mind/Body dualism Medicine should focus on
  measuring cells biochemical changes by precise
  technique, explain symptom, interfere changes to
  recover the health
• Reductionism disintegrates human body to
  different organ, cells and molecular, the
  physical and chemical changes at molecular levels
  can explain the causality of functional changes
  of body
• Disease is regarded as a static results between
  its cause and effects

31
???????--????????Boom of Life science

• Germ theory
• Physiology
• Anatomy
• Histology
• Embryology
• Pathology
• Immunology
• Genetics
• Molecular Biology

• ?????
• ???
• ???
• ???
• ???
• ???
• ???
• ???
• ?????

32
Achievements under bio-medical model??????????

• ???? ????
• ??
• ??
• ??

• Three big issues
• in surgery
• ache
• Infection
• Blood loss

33
???????Pasteur Germ Theory

• diseases were transmitted by micro-organisms
  'germs that float in the air
• 1870's Pasteur demonstrates that germs are the
  cause rather than the product of disease
• 1880's Robert Koch - 'Doctrine of Specific
  etiology'
• each disease is always caused by a particular
  micro organism

• ??????????????????????
• 1870s,?????????????????????
• 1880s???????????????
• ??????????????????????

34
?????????Rudolf Virchow, German pathologist

• Father of Cellular Pathology
• Disease can be manifested at microorganism level.
• All diseases have relation to cell, the source of
  all kinds of diseases is cells abnormal
  activities

• ???????
• ?????????
• ?????????
• ????????
• ?????

35
Ecological model of disease
?? host
?? environment
??? pathogen
36
Defects of biomedicine mode

• Engel (1980) biomedical model neglects the whole
  because it excludes everything but biological
  factors.
• It is preoccupied with the body and disease at
  the expense of the patient as a person.
• modern allopathic medicine often fails to address
  the emotional and spiritual needs of those who
  suffer from infirmity

• ????????????,?????????,????????
• ??????????????,??????,????????????????????????

37
???????????? (Bio-psycho-social medical model)

• Holistic-Rather than a new approach, the
  bio-psycho-social model is actually a return to
  holism
• Interaction of body and mind
• Multi-causality
• Socially connected individual
• Preventative - health maintenance

• ?????
• ????????
• ????---???
• ????????
• ??????????

38
(?)??????????????? The background of
bio-psycho-social medical model

• ?????
• ??????????
• ??????
• ????????????????

• Changing of disease Pattern
• Increasingly diversified demand for health
• Socialization of medicine
• Interior amalgamation and exterior intersection
  of medicine disciplines

39
Emerging of Bio-psycho-social medical model

• ??????????????-??-???????????????
• ??????????????????????????????,????????????
• ??????????????????????????????

• George Engel, alternative to the limited,
  predominant biomedical model.
• Bio-medical-model, accounts for disease by its
  biochemical factors without considering social or
  psychological dimensions, separates mind from
  body. It is a reduced, myopic view.
• Emphasize the hierarchical, independent
  relationships of biological, individual, family,
  and community systems.

40
Emerging of Bio-psycho-social medical model

• It includes the patient as well as the illness
• Emphasize close attention to be placed on the
  medical illness and the role the illness plays
  in the emotional life of the patient, and the
  interpersonal dynamics of the family.

• ?????????????????
• ????????????,?????????????????,???????????

41

• ?2-1 ???????????????

1957 1957 1963 1963 1975 1975 1985 1985 2001 2001
? ? ???() ? ? ???() ? ? ???() ? ? ???() ? ? ???()
1.????? 16.9 ??? ??? 12.0 ??? ?? 21.6 ??? ?? 23.39 ???? 24.93
2.??? 15.4 ??? 10.7 ???? 18.8 ??? ?? 20.98 ??? ?? 20.41
3.????? 7.3 ???? 8.6 ??? ??? 18.6 ???? 20.32 ??? 17.61
4.????? 6.6 ??? ?? 6.9 ??? ?? 11.7 ??? ??? 9.08 ??? ??? 13.36
5.????? 5.5 ??? ?? 6.7 ??? 5.8 ????? 4.17 ????? 5.87
42
(?)???????????? (Environment health medical
model)
43
(?)????????????????(Comprehensive health
medical model)

• ????
• ?????????
• ??????
• ????????

44
????
? ?
????
????
? ?
? ?
????
????
? ?
? ?
? ?
? ?
? ?
? ? ????
? ? ????
? ? ????
????
?2-4 ????????
45
(?)????????????? Engel
Bio-psycho-social medical model
46
??????????????????????????,?????????????Worl
d Health Organization 1948A state of complete
physical, mental and social well being and not
merely the absence of disease or infirmity.
(?)?????????????? (Views of health of modern
medical model )
47
??????????????????????(three dimension)?

• ????? ?????
• ??????? ??????,
• ?????? ??????

48
????????????????????????????????????????
??????????(disease) ???????(????),??(illne
ss) ????????????(????)??(sickness)
????????????? (????)?

49
????? (sub-health state )
?????????????,????????,?????????????????,?????????
?????????????,??????????????????????,??????????
??
???? ??
???? ??
???? ???
50
?????(subclinical disease) ???????(
non-symptom disease)?????????????????????????????
??,?????????,??????????????????
51
????????????? ????????( Impact of
bio-psycho-social medical model on medicine and
society)
52
1.?????????????????Significance of modern
medical model

• Clinical medicine
• Preventive medicine
• Medical education
• Sustainable development
• Goal of medicine

• ????
• ????
• ????
• ?????
• ????

53
?????????? ?????( five star doctor)

• ????????
• ????????
• ????????
• ????????
• ????????

• Care Provider
• Decision Maker
• Health Educator
• Community Leader
• Service Manager

54
2.??????????????? (The goals of
bio-psycho-social medical model)
55
???????????? The major challenges facing by
medicine and the goals of medicine are

• ???????????????
• ?????
• ??????

• The rapid increasing of medical costs become
  unaffordable
• The confusion exists in clinical practice
• The fairness of society is oppressed

56
?????????? Mature and accomplished medicine

• ?????????????
• ???????????????????
• ???????????
• ????????????

• Should be moderate and cautious
• Should be medicine that could be offered by
  society and be affordable in economy
• Should be equity and fairness
• Should respect the choice and dignity of people

57
?????????????????Priority strategies of
bio-psycho-social medical model

• ?????????
• ???????
• ?????????????
• ?????????????

• To prevent disease and promote health
• To relieve pain and distress
• To cure disease and care incurable disease
• To avoid the premature death and advocate
  comfortable death

58
??Summary

• ???????
• ??????????
• ????????????????