Medicine's Role in Comprehensive Care

PERSPECTIVES IN BIOLOGT AND MEDICINE Volume 15 · Number) · Spring 1972 MEDICINE'S ROLE IN COMPREHENSIVE CARE* DONALD G. BATES, MX)A The Meaning of "Comprehensive" "The task of today's medical schools can be no less than the 'creation of the future' in the field of health care" [I]. Thus begins one of the most basic reviews of the vast literature on educational reform in medicine. In its vision and in its rhetoric, this statement typifies the language of medical reform in the 1960s. Medical care is now "health care," medical schools are now "health sciences centers," and medical personnel are now "the health professions." Undoubtedly, the widespread preference for "health" over "medical" owes much to fashion, but there would seem to be a deeper significance to its sudden prevalence. It may have something to do with an age which loves euphemisms and the power of positive thinking. Perhaps it is an attempt at times to stress the preventive aspects of medicine. But surely it is chiefly employed because of its connotations beyond the "purely medical," that is, beyond the purely biological aspects of illness. "Health" is preferred over "medical" because it is a means of conveying the notion of "comprehensiveness." * This paper is a slightly modified version of the first chapter of an unpublished report to the dean of medicine: "Undergraduate Medical Education and the Needs of Society." As chairman of a curriculum subcommittee on the objectives of undergraduate medical education, I wrote the report and the present revision of the first chapter and wish to express my deep appreciation to the other members of the committee: K. Dawson, internist; C. Forget, economist; Mrs. S. Goldbloom, professor of social work; C. Larson, medical student; J. Leila, medical sociologist; M. Magor, clergyman; Miss E. Robinson, medical student; R. Shepherd, resident in psychiatry; N. Steacy, clergyman; L. Warshaw, professor of architecture. The thoughts expressed are those of all of us and the mode of expressing them the result of everyone's careful review of each draft of the original report. I am more than indebted to these other members; they are equally the authors of the concepts, if not of the words, which are set forth here. t Department of the History of Medicine, Faculty of Medicine, McGiIl University, Montreal 2, Canada. Perspectives in Biology and Medicine · Spring 1972 | 317 The term "comprehensive care" has, itself, enjoyed wide usage. Possibly stemming from the vocabulary of medical insurance, it has come to be one of the chief watchwords of medical reformers. It is used in at least two ways. First, comprehensive care refers to the reintegration of medical services which have been fragmented by specialization ; it expresses a searching after that elusive quality of medical care: the general, all-purpose, conveniently coordinated delivery of traditional medical services.1 But, as reference to the term health suggests, there is a second meaning implied by comprehensive—the provision of a broad range of services well beyond those available for purely biological problems [3]. It suggests the broadening of the scope of medical responsibilities to include much more than what had been previously regarded as traditional medical concerns. It is this second meaning of comprehensive which will be considered here. Comprehensiveness and the Definition of Medicine's Responsibilities One of the problems which arises from this more comprehensive comprehensiveness is that the definition of medicine is becoming vague and the responsibilities of the medical school correspondingly unclear. Efforts to broaden the outlook and capacities of medicine threaten to create a serious loss of cohesiveness and sense of purpose unless they are balanced by parallel efforts to keep in sight medicine's essential and unique responsibilities. The complications arising from this loss of definition are very real. For one thing, a commitment to comprehensiveness can become a commitment to some indivisible continuum of care and responsibility which must be encompassed by the skills and knowledge of one individual. This leads to such statements as "the physician of the future will be called upon to be a superb technician steeped in quantitative biology, physics and engineering, to be equally equipped for treatment and for prevention of disease, and to be cognizant of the social, economic and psychologic...