by The Open University
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Sally and Richard Greenhill
©Sally and Richard Greenhill
Figure 1: A consultant on a ward round talking to colleagues and leaving the patient isolatedRead the following description of the biomedical model. Then list what you would consider are (a) the positive and (b) the negative implications of it for lay users.
Biomedicine (which is also known as allopathy, conventional medicine or modern western scientific medicine) is relatively new, unlike some ancient healing systems which have been practised for several thousand years. In the UK biomedicine dominates contemporary and official understandings of health and forms the basis of the NHS and other western health care systems. While the biomedical model is considered the epitome of scientific, objective, reproducible medicine, the actual delivery of health care may be somewhat different in practice. The following statements about biomedicine thus represent an idealised, necessarily artificial version of this model.
Health is predominantly viewed as the ‘absence of disease? and as ‘functional fitness?.
Health services are geared mainly towards treating sick and disabled people.
A high value is put on the provision of specialist medical services, in mainly institutional settings, typically hospitals or clinics.
Doctors and other qualified experts diagnose illness and disease and sanction and supervise the withdrawal of service users from productive labour.
The main function of health services is remedial or curative ? to get people back to productive labour.
Disease and sickness are explained within a biological framework that emphasises the physical nature of disease: that is, it is biologically reductionist.
Biomedicine works from a pathogenic (origins of disease) focus, emphasising risk factors and establishing abnormality (and normality).
A high value is put on using scientific methods of research and on scientific knowledge.
Qualitative evidence (given by lay people or produced through academic research) generally has a lower status as knowledge than quantitative evidence.
(Source: adapted from Jones, 1994)
(a) Biomedicine has advantages as well as disadvantages for the consumer. For example:
Biomedicine provides diagnostic categories and ways of dealing with pathologies that may help in the treatment or prevention of life-threatening illnesses.
Biomedicine provides an easily identifiable structure which users can navigate to get their health needs addressed.
Biomedicine provides effective treatment for many serious illnesses ? for example, bypass surgery for heart conditions ? which in the past may have resulted in death or long-term disability.
Biomedicine produces experts who are highly specialised.
(b) However:
Some medical interventions can have serious side effects.
The user's view of why they are ill is not prioritised by biomedical practitioners.
The use of technology may yield a diagnosis of disease which does not tally with how the user feels.
Specialisation may imply a narrow focus and might lead to the practitioner neglecting interactional processes.
Biomedicine is potentially the most polarised of all health care models. In its idealised form, biomedicine considers ‘professional knowledge? to be expert, rational and scientific. Lay beliefs, by contrast, are perceived as ill informed, non-rational, unscientific and superstitious, and are thus devalued. According to this theory, lay people have beliefs and doctors have knowledge (Bury, 1997). In the biomedical model, symptoms are prioritised to the extent that they conform to diagnostic models. The doctor's job is to diagnose relevant symptoms.
In biomedicine the focus is on objective, measurable phenomena, and technology can be used to achieve diagnoses. Advances in medical technology led to a greater ability to localise disease processes within the body, so that sites of pathology could be pinpointed with greater accuracy (Helman, 2001). Although this is of great benefit to users and clinicians, the process ‘has also contributed to a narrowing of medical vision ? to the reductionism, mind-body dualism and objectification of body so characteristic today of the disease perspective? (Helman, 2001, p. 65). Normality is established by referring to statistically derived ranges, which do not take account of the individual (for example, a person may always have had ‘abnormally low? blood pressure).
Biomedical practitioners are criticised for being more interested in symptoms than in people: for example, a stereotypical hospital ward round in the past might have involved the consultant being directed to ‘the duodenal ulcer in bed seven?. Greenhalgh and Hurwitz describe the problem as follows.
At its most arid, modern medicine lacks a metric for existential qualities such as the inner hurt, despair, hope, grief, and moral pain that frequently accompany, and often indeed constitute, the illnesses from which people suffer.
(Greenhalgh and Hurwitz, 1999, p. 50)
In the biomedical model attention focuses on physical symptoms, and the emotional side of a service user's health state is secondary, except in psychiatric services. Effective doctor?patient (‘patient? being the correct term in biomedicine) communication is relevant in that the patient needs to understand what is expected of them, so they can comply with instructions, such as adhering to a regimen, taking medication, and so on. There is no standardised model for health provider?user interactions. These vary considerably depending on the familiarity between the parties and the nature of the consultation: for example, an encounter with a familiar general practitioner is different from a single encounter with a radiographer.
Critics of the biomedical model usually cite the depersonalised, objectifying nature of biomedical practice, such as focusing on the disease rather than the individual. Fuelled by technology, biomedicine promotes a reductionist interest in the body in which, as Helman (2001) puts it, ‘specialists learn more and more about less and less?. The risks of conventional medicine also cause concern.
If the biomedical model characterises the theoretical underpinnings of scientific medicine, the biopsychosocial model has replaced it as the model that best characterises contemporary western health care delivery.
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