Below you will find the abstract for the talk on this topic as part of the International Seminar on Innovation in Primary Care.
Health extends well beyond the absence of
disease or infirmity, which focuses solely on the negative range of the health spectrum.
Disease based thinking, however, is a paradigm that has helped enormously in
advancing medicine.
It easily accommodated infectious health problems that had a clearly identified
and simple etiology: there was a single cause for each problem and dealing with
(curing!) the disease was basically an issue of dealing with responsible
etiological agent. This continues today in the form of claims for the discovery
of gens that are responsible for health conditions, for personality traits and
even complex psychological functions. Progressively and unopposed, the idea
crept in that health was just about ensuring that the heart worked, the lungs
worked, the kidneys worked. And progressively the patients disappeared behind their
conditions when not simply their organs.
Surely a straw man in our days? Unfortunately
not. A prime example is at hand: the Quality and Outcomes Framework, the
biggest initiative for pay for performance in the world, has provided General
Practitioners in the UK with financial incentives for managing their patients.
All clinical incentives in this framework are condition specific. The implicit
assumption is that patients can be reduced safely and effectively to their
blood pressure, their renal function, their cholesterol levels. And yet we know
this is not the case.
