The Development and Impact of the Medical Model

THE DEVELOPMENT AND IMPACT OF THE MEDICAL MODEL HANNU VUORI* and MATTI RIMPELAf The purpose of this paper is to describe the development of three philosophical notions that we consider to be the basic components of the medical philosophy, often termed the medical model, and the impact of this model on the content of medicine. The notions concern man's relationship to nature, man himself, and the nature of disease. These notions have blended into a strong philosophical undercurrent, specific to medicine, shared by the health professionals, and capable of influencing the content of health care. The concept of medical ideology has sometimes been used to describe the same phenomenon. We maintain , however, that there cannot be any ideologies internal to medicine if one wants to use the term in its conventional, dictionary sense. We do not deny the influence of external factors on medicine, but we consider this to be in many instances a two-stage process: external ideological factors may create a fertile soil for the adoption ofcertain philosophical notions into the medical philosophy. Once the philosophy has been formulated, it becomes relatively self-sustaining, although there are signs of this philosophy now becoming more susceptible to external influence. The Determinants ofHealth Care Our point of departure is the claim that currently the bulk of medical thinking is dominated by a very universal philosophy that can be called the medical model [1], which we consider a more important determinant of health care than the external ideological factors. External ideologies are related to the form of health care, the internal philosophy to its substance. In medicine, the organization of health care—the form— largely determined by environmental factors including the prevailing ideologies may vary, but the substance is remarkably uniform and uni- *Professor and chairman, Department of Community Health, University of Kuopio, POB 140, 70101 Kuopio 10, Finland. This paper was written while the author was a visiting scientist at the National Center for Health Services Research, Hyattsville, Maryland. tChief, Health Education Unit, National Directorate of Health, Helsinki, Finland.© 1981 by The University of Chicago. 0031-5982/81/2402-0214$01.00 Perspectives in Biology and Medicine · Winter 1981 | 217 versal. The medical philosophy seems to permeate most health-care systems regardless of the political system and the level of socioeconomic development and appears to be resistant to change. Even a cursory look at some health-care systems is sufficient to evince the pervasiveness of the medical philosophy. There are, of course, exceptions . The most notable one is probably China, but even China seems to be returning to the mainstream of medicine after a detour to barefoot medicine and other interesting forms of health care based on a different philosophical foundation. The United States also seems to be more pluralistic in this respect than Europe. The industrialized nations have been surprisingly successful in selling their own health-care models to the developing countries. The crux of this success is probably the fact that the selling has been done by health professionals and the recipients have been health professionals educated in the same philosophical climate as the sellers. No one has questioned the applicability of the medical norms and values. In spite of ideological differences and different organization of health-care systems, the content of health care is virtually identical in socialist and capitalist countries. In fact, the socialist countries seem to cling to the "medical model" even more tightly than the capitalist countries , although, they otherwise are much more aware of the role of socioeconomic-political factors. In some countries, the authority of the medical profession may be challenged, but there is a movingly unanimous belief in the power of medicine. The Medical Philosophy The medical philosophy is an idealized construct in the sense of the sociological concept of typology. Our selection of its basic ingredients can be criticized for arbitrariness. Since the time of Max Weber and his Protestant ethic and the spirit of capitalism, the sociologists have, however , availed themselves, with good results, of very boldly simplifying typologies as theoretical and analytical tools to identify, highlight, and analyze the most salient features of the phenomena under scrutiny. Our suggestion that the main components of the medical philosophy...