 Holistic medicine and technology: A modern dialecticPaul J. Rosch and Helen M. Kearney Social Science & Medicine, 1985, vol. 21, issue 12, 1405-1409 Abstract: This is an attempt to present a comprehensive overview of two major trends in American medicine which suggests significant evolutionary biopsychosocial developments in the remaining decades of the 20th century. Comments have been confined to the U.S. because it is the geographical country of residence and practice of the authors, and because the U.S. appears to be the locus of two contemporaneous and seemingly antithetical popular movements: quantum leaps in the development and use of medical technology and a groundswell of interest and enthusiasm for health enhancement or wellness which advocates a natural approach to health and emphasizes the central role of the individual in the preservation of health and the prevention of illness. The dynamics of this modern dialectic in American medicine have generated important qualitative consequences in the nature of the doctor-patient relationship and the delivery of health care. They have also, it is submitted, generated the search for a new paradigm which will permit a workable equilibrium between the disparate imperatives of both movements. The delicate process of developing that equilibrium is made more difficult by the co-existence of a host of complex factors, many of which are inextricably interwoven with one or the other of these two major trends. As component or ancillary factors in the technological revolution, American physicians are witnessing: 1. (1) The ongoing computerization of medicine via increasingly sophisticated diagnostic and therapeutic instrumentation which contribute to a depersonalization of the patient. 2. (2) An explosion of new theory and design, in computerized techniques which physicians must keep abreast of, with the resulting decrease in time available for patient care. 3. (3) A trend toward specialization and sub-specialization in medicine and a compartmentalization of patient care which increase the quantity of medical care in terms of specialists seen, diagnostic procedures performed and various blood tests administered, but decrease the quality of direct physician-patient personal interaction. 4. (4) A reimbursement system which recognizes only procedural services but not cognitive skills, thereby remunerating the physician for doing something to the patient--surgery, X-rays, blood tests, etc. Compensation is based on objective services which can be quantified and assigned a specific monetary value but not for subjective services such as listening, counselling, empathy, or caring. At the opposite pole of the dialectic are the components of the 'holistic' health movement: 1. (1) Patient interest in naturopathic approaches to healing which has created an educated, remarkably well-informed patient population. 2. (2) An appreciation of the multi-faceted approach to 'wellness' which acknowledges the role of nutrition, diet, exercise, behavioural modification, etc., in the enhancement of health and the prevention of illness. 3. (3) A wariness if not an anxiety regarding the long term consequences of pharmacologic intervention as well as the potential hazards of irradiation, thermography, sonography, etc. 4. (4) The appearance of number of entrepreneurs and even charlatans who seek to exploit the appeal of 'holism' or naturopathic approaches. Many of the programs they advance, irrespective of merit, evoke some degree of enthusiasm and adherence, and even achieve therapeutic success. Physicians are hard-pressed to become sufficiently familiar with acupuncture, shiatsu, kinesiology, Rolfing, macrobiotic diets, etc., to make informed judgements and to counsel their inquiring patients. 5. (5) The growing numbers of competing health professionals and para-professionals (psychologists, podiatrists, physician's assistants, nutritionists, etc.) who are encroaching upon the physician's traditional preserve of patient care. As a partial response to these currents and trends, the definition of the traditional doctor-patient relationship is undergoing revision. Emerging is a new and equal partnership between healer and healed based upon a fundamental assumption that the physician and patient are co-therapists, and while the doctor remains the repository of medical knowledge and technical expertise, the patient is the covalent source of those factors without which no healing can take place: confidence, faith, hope, optimism and intelligent cooperation. However, such a restructing will not come easy. Many physicians are reluctant to relinquish their comfortable and familiar authoritarian role and are resistant to recognizing their own limitations, those of their wondrous technology, and the integral contribution the patient can and must make to their mutual effort to preserve health and cure disease. The patient will also have to assume his or her own share of that responsibility, eschewing the image of the body as a simple machine, ("if it breaks--doc can fix it!") and consciously acknowledge that individual behavioural patterns directly influence the quality of one's health and the incidence of disease. In reality, the 'new' relationship is only the most recent manifestation of the classical psychosocial bond between mind and body, healer and healed. Contemporary medicine in the U.S. is confronted with difficult and perhaps painful choices in developing a functional synthesis of the two trends described above. However, it is submitted that after 2000 years, allopathic and holistic medicine need no longer be perceived as mutually exclusive creeds. The earliest healers were high priests who taught and practiced a philosophy grounded on an inseparability of body and mind in a positive state of health and well-being. Life reflected that fundamental integrity. Only if today's high priests of medical technology will blend their reverence for science with a dedication to the humanistic values that characterized their descipline's early practitioners can medicine achieve that early unity of thought and deed, that coalescence of the art of healing and the science of medicine. Date: 1985 Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:21:y:1985:i:12:p:1405-1409 Ordering information: This journal article can be ordered from Access Statistics for this article Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian More articles in Social Science & Medicine from Elsevier |
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