Interne geneeskunde : wetenskap en kuns

Abstract

The spectacular growth of medicine in this century is a reflection of the tremendous advances in physiology and biochemistry; the basic scientific discipline of modern internal medicine is molecular biology. The success of this approach has led to a biomedical model of disease which is based on a reductionist philosophy whereby all life phenomena are considered to be derived from a single particle and disease processes are the result of deranged chemical reactions. There are, however, severe defects in the reductionist approach to sickness. The human being is more than a mixture of chemical compounds, and the true nature of health and disease cannot be completely understood at the chemical level. Man is also soul: his sickness and health depends on a complex interplay between biologic, social, psychologic and cultural factors. This can best be explained by looking at the difference between disease and illness. Diseases are abnormalities in biological and physiological processes of the organ systems of the body - these abnormalities are the main concern of the modern doctor. Illnesses, on the other hand, represent the patient's experience of sickness, the personal or cultural reactions to disease. Both these views are inadequate to explain the total phenomenon of sickness. Many patients with normal biochemical profiles are, in fact, desperately ill, whereas some individuals who are well have abnormalities of their chemical content and are considered to be ill. It is clear that the biomedical model of disease, consisting of the concept of reductionism and mind-body dualism, must be replaced by a biopsychosocial model. Behavioral and social science should be taught in medical faculties in order to provide students with a better understanding of proper health care.