What stages has the human medical model gone through?

The development of the medical model has gone through five stages: the deistic medical model, the natural philosophical medical model, the mechanistic medical model, the biomedical model, and the biopsychosocial medical model.

The medical model is a synthesis of the basic concepts, conceptual frameworks, ways of thinking, and developmental norms of medical development in a certain period of history, mainly reflecting the viewpoints and methods used by people to study and deal with problems at all levels of medicine. It is the basic idea and the main method of observing and dealing with the relevant problems in the field of medicine gradually formed in the process of medical practice activities, and its core is the medical view.

Medical model includes medical cognitive model and medical behavioral model, the former refers to a certain historical period of people's understanding of medicine itself, that is, the epistemology of medicine; the latter refers to a certain historical period of people's behavioral paradigm of medical practice activities, that is, medical methodology.

I. Characteristics and role of the medical model

The evolution of the medical model is the natural law of social and medical development and the inevitable process, the different stages of the medical model, with its *** characteristics, and affects the medical thinking and action.

(A) medical model of ****ity characteristics

Medical model of the emergence of social, medical model of the existence of universality, medical model of the can influence has a wide range of medical model of the development of dynamic.

1. The social nature of the medical model

The medical model is produced in the context of society, and its creation and evolution is the product of the development of natural and social sciences, which is closely related to the development of society. The process of human civilization is synchronized with the continuous development and innovation process of human worldview, methodology, science and technology. The evolution of medical model is the natural law and inevitable process of social and medical development.

2. The universality of medical model

Medical model is a subjective reflection of objective things, but also a philosophical concept of objective existence. The medical model exists widely in medical practice, and thus has the objectivity and universality, which is manifested in that it is not shifted by human will, and the concept of health and disease awareness is universally rooted in people's minds.

3. Wide influence of medical model

Theory guides practice, and the influence of theory on practice is extensive. Medical model is the development of medicine to a certain period of time and the formation of a high degree of understanding of medical science and its historical generalization and summary, that is, the systematic medical theory, the theory of medical practice related to behavioral activities have a far-reaching impact.

The extensive influence of the medical model is reflected in the modern medical model, which plays an important role in guiding the theory and practice of medical science and health care in various fields, making modern medicine show "high synthesis" and "high differentiation" of the two-way development situation. Bidirectional and progressive development trend.

4. Dynamic development of medical model

Medical model is dynamic, progressive development, not static. This progressive development of the medical model is in line with the natural laws of social and medical development. The continuous change of social productivity, the change of political and cultural background, the development of science and technology and the progress of philosophical thinking are the driving force for the transformation and evolution of the medical model. The new medical model is a new leap and breakthrough in the development of the old medical model to a certain extent, which is a process of continuous abandonment and sublimation, i.e., in the cyclic pattern of "medical practice-establishment of medical model-medical re-practice-establishment of the new medical model". The process of "medical practice-medical model establishment-medical re-practice-new medical model establishment" is a process of constant abandonment and sublimation.

(2) The role of medical model

Medical model can also be considered as the application of the modeling principle of scientific research in medicine. It is both the result of people's understanding of medicine and represents a medical research methodology. The medical model arises in the medical practice, highly abstract and generalized in the form of concepts to express people's view of health and disease in a specific period, and also reflects the relationship and nature of the overall structure of medicine in a specific period, and reflects the field, method and goal of medical research.

All medical scientific research and medical activities are guided by a certain view of medicine and epistemology, and thus are carried out in a certain medical model. The medical model is formed in practice, which in turn affects people's view of medicine in the form of concepts, which in turn affects people's medical thinking and medical action.

Second, the evolution of medical model

Medical model as a medical as the object of observation and study of the view of nature and methodology, with a certain social and historical background, a certain level of scientific and technological, philosophical thought of the overall level of adaptability. A certain medical model is relatively stable in a certain period of time, while the change of social and historical background, the progress of human science and technology, and the overall improvement of the level of philosophical thought will inevitably bring about the turnover of the medical model. The transformation of the medical model is not a mere substitution process, but a process from quantitative change to qualitative change, constantly transcending, perfecting and sublimating.

In addition, after the new medical model is created and functions, the old medical model will not immediately disappear or lose its effect, and will still have some influence in some medical fields.

Each stage of medical development has a corresponding medical model that reflects the state and level of medical development in that period. Medicine has gone through different stages of development of ancient medicine, modern medicine and modern medicine, and the medical model has also gone through the deistic medical model, the natural philosophy medical model, the mechanistic medical model, the biomedical model and the bio-psycho-social medical model.

This gradual and progressive evolution is in line with the overall law of medicine. As human understanding of the nature of medicine more in-depth to, there will be more in line with the needs of scientific development, more adapted to the emergence of new models of modern human health care. Therefore, the evolution of the medical model is continuous, continuous improvement, never finished.

(I) Spiritualism medical model (spiritualism medical model)

Since ancient times, due to the limitations of the understanding of disease, the ancients believed that life and health is God's gift of the gods, diseases and calamities are the punishment of the heavens or evil demons human body; and death is the spirit of the gods to recall the soul; the treatment of disease will be entrusted to the gods of the plague, prayers to worship heaven or "jumping to the sky". The treatment of illnesses was placed on getting rid of the plague gods and praying for the restoration of health by worshipping the heavens or exorcising evil spirits by "jumping to the big god". This led to an early view of health and disease, in which supernatural spirits governed human health and disease.

Under the influence of this thinking, people mainly relied on praying to the gods for forgiveness, and on witch doctors to exorcise evil spirits in order to maintain health and cure diseases. That's why witchdoctors in those days often made their living by pleasing their patients, and it was more important to please them with some of their so-called witchcraft than it was to go head-to-head with the disease. Mr. Trudeau's phrase "always comforting" is a true reflection of this period, or a kind of helplessness, reflecting the state of mind of that era.

Divine medical model is in the scientific thinking has not yet been established, productivity is extremely low, the extreme worship of supernatural power in the background, the use of supernatural power to explain human health and disease, is the backward productivity of mankind in the early days of the low level of science and technology, reflecting the primitive religious thinking and idealistic philosophical outlook, such a model should be discarded.

(2) natural philosophical medical model (natural philosophical medical model)

With the progress of human society and the deepening of the understanding of nature, people began to gradually get rid of the shackles of religion, the natural phenomena have a more rational and objective understanding of the natural phenomena, and began to try to draw on the natural world of substances and phenomena to explain the disease. People in this period advocated the integration of man and nature, consciously linking the disease with the natural and social environment, and gradually formed a more simple, dialectical model of natural philosophy of medicine.

With the objective existence of natural phenomena and the law of development to recognize, observe and think about health and disease, which is the initial transformation of mankind from idealism to materialism. The most representative of this is the "four-body fluid theory" put forward by Hippocrates, the "father of medicine" in ancient Greece, and the "yin-yang and five-element theory" of Chinese medicine.

Natural philosophy medical model of the human body and the understanding of the origin of disease has been freed from the constraints of the supernatural forces with a mysterious role, people began to use their own intuitive material factors such as "four body fluids" "yin and yang and five elements" to explain life, health and disease, with the power of atheism, to explain the power of the body, the body and the disease, and to use the power of atheism to explain the power of the body. Disease, with the power of atheism to expel the ghost of spiritualism from medicine, this is the historical progress of the medical model. Based on this medical model, a systematic medical theory system of ancient China and Arab medicine emerged in Central Asia.

But the natural philosophy model of medicine, like natural philosophy, is limited by empirical philosophy and the level of science and technology, is based on intuition, and sometimes relies on ideological speculation to make up for the shortcomings of observation, and in this way has certain shortcomings, and will inevitably be replaced by a progressive model of medicine.

(C) Mechanistic medical model (mechanistic medical model)

In the second half of the 15th century, the Renaissance movement in Europe promoted social change and the development of productive forces, machine production instead of manual production, people gradually get rid of the constraints of religious theology, and turn to promote mechanical determinism. So the rise of mechanical determinism as the leading experimental philosophical thinking, mechanistic medical model gradually formed. The representative figures are the French philosopher and scientist R. Descartes (R. Descartes, 1596-1650) and the French physician Lametrius.

Descartes proposed in his book "Animals and Mechanisms" that animals and the human body are sophisticated machines with various functions, and all physiological functions can be explained as the movement of material particles and the thermal movement produced by the heart, which he compared to a heat-making machine. Lungs compared to a cooling machine, nerves, muscles and tendons movement compared to the pilot police and clockwork, with mechanical principles to explain the function of the human body.

Rametri published a book "man is a machine", that "the human body is their own machine, disease is a part of the machine is out of order, the need to repair perfect". Since then, human inquiry into medicine into the experimental science and mechanical theory of the era, the formation of modern "force" and mechanical movement to explain all natural phenomena of the metaphysics of the mechanical materialism of the concept of nature.

The mechanistic model of medicine prompted people to observe the human body and explain diseases from the perspective of matter and movement, breaking through the limitations of religious theology and idealistic philosophy, and leading medicine from empirical medicine to the era of experimental medicine, applying experimental methods to the field of medicine, and facilitating the rapid development of anatomy, physiology, pathology, and surgery, which had a profound impact on modern medicine. However, it also has certain high limitations, people mostly utilize the mechanical view to explain all human body phenomena, but ignore the biological, social and psychological complexity of human beings.

(4) Biomedical model

The second half of the 18th century and the 19th century saw the epoch-making discoveries of the 19th century - the law of conservation and transformation of energy, the theory of biological evolution and the cellular theory, which greatly shook the foundation of mechanical materialism. At the same time, immunology, pathology, biochemistry, histo-embryology, molecular biology and other life sciences were introduced one after another, which provided the necessary technical support and scientific basis for solving the major problems in the field of medicine, and pushed the whole medical science from empirical medicine and experimental medicine to the process of modern medicine.

As a result, people have a more scientific understanding of the changes in the organism and the phenomenon of life, as well as health and disease, and so the modern biomedical model based on biomedicine was born.

The biomedical model pursues the law of cause and effect, and uses the logic of "observation, hypothesis, proof, and conclusion" to explain, diagnose, treat, and prevent diseases. Any disease is a disorder of the biological mechanism, which can be found in organs, cells and biological macromolecules with specific cavitation of morphology, structure and biological indicators. The purpose of medicine is to measure these changes through sophisticated techniques to interpret the signs and symptoms of the patient so that appropriate treatments can be applied.

Particularly with the ongoing breakthroughs in genetic research, medical scientists mistakenly believe they have found the golden key to finally attacking disease, and the medical community has fallen into an unprecedented level of blind confidence.

Many believed that it seemed as if all diseases could be conquered, and that doctors had enough power and authority to challenge disease, including defeating aging, conquering cancer, and denying death. Technological expansion has been accompanied by a great neglect of medical humanistic endeavors by the medical profession, and in the eyes of many doctors there is only disease, not patients, and only technology, not comfort.

The greatest contribution of the biomedical model to medicine lies in disease control and disease prevention. The application of sterilization in surgery has significantly reduced the rate of postoperative infections; the invention and application of anesthetics have solved the problem of pain; the introduction of antimicrobials has effectively controlled infections; and the use of the three major treasures of sterilizing and killing worms, preventive inoculation, and antimicrobials has helped to overcome acute infectious diseases and parasitic diseases.

In addition, the biomedical model promotes the all-round and multi-disciplinary development of biomedical sciences, forming a large number of disciplinary fields that are vertically in-depth and horizontally interconnected and permeable to the medical network system, to the middle of the 20th century, has formed a huge disciplinary system of more than 50 categories and hundreds of subdisciplines, with molecular biology as the core.

The contribution of the biomedical model to mankind is enormous, but with the development of society, people's requirements are getting higher and higher, and the limitations of the biomedical model are becoming more and more prominent. Firstly, it over-emphasizes the biological attributes of human beings and focuses only on the biomedical aspects of diagnosis and treatment, without considering the influence of psychological and accounting factors on the occurrence, development and regression of diseases. Second, the use of decomposition and reduction to study the structure and function of the human body and the pathological changes of disease.

Only focusing on the local but ignoring the whole, the human body disease dismembered into organ disease, ignoring the patient's social environment and the impact of psychological factors. Finally, the metaphysical approach to the study of the human body prevents a comprehensive understanding of the comprehensive factors affecting the internal changes of the human body, and does not ethically care for, understand and relieve the patient, leading to alienation and tension in the doctor-patient relationship.

(E) Bio-psycho-social medical model

Since the 1950s, the "spectrum of disease" and "spectrum of cause of death" have been changed. The "spectrum of disease" and the "spectrum of causes of death" have undergone important changes since the 1950s. Infectious and parasitic diseases are no longer the main threats to human health, while heart disease, malignant tumors and cerebrovascular disease are the top three causes of death. With the development of globalization and urbanization, environmental pollution, psychological stress, smoking, alcoholism and other risk factors are widely exposed, the incidence of chronic non-communicable diseases (referred to as "chronic diseases") has risen sharply.

The biomedical model, which focuses only on biological factors, is no longer able to solve the health and disease problems of today's human beings, and must also take into account the effects of biological, psychological, and social factors on the human body and mind. The biopsychosocial model of medicine was formally proposed by G.L. Engel, a professor of psychiatry and internal medicine at the University of Rochester School of Medicine, in the journal Science in 1977.

"Biopsychosocial medicine model" believes that human health and disease depend on various factors such as biological, psychological and social factors, and that to maintain and promote human health, it is necessary to make efforts from people's living environment, behaviors, spirituality and health services. The Biopsychosocial Model of Medicine The biopsychosocial medical model is a medical model that recognizes human health and disease from both biological, psychological and social aspects. It is a multi-causal, multi-fruit, three-dimensional networked medical model based on the biomedical model.

It requires that human beings be regarded as a whole with biological and socio-cultural attributes, and that human beings and the natural and social environments in which they live be considered as a whole. It calls for analyzing disease, the patient, and the health care system as a subsystem of the larger social system. It understands the causes of health and disease from a multifaceted perspective and explores the means of disease treatment and disease prevention in a multifaceted way. That is, it is characterized by wholeness, systemicity, and plurality.

The modern medical model does not deny the role of biological factors in the occurrence and development of diseases, and does not deny the significance of physiological and biochemical indicators in the diagnosis of diseases, but only emphasizes their role and significance at a higher level. Biological factors, psychological factors, social factors **** the same constraints on human health and disease, disease is not only caused by biological factors, but also take into account the social and psychological factors, to consider people as a unified whole, and to further emphasize the role of psychological and social factors in the causation of disease and its impact in the process of disease prevention and rehabilitation.

While biological factors remain at the core of the modern medical model, psychological and social factors should play a more important role in medical behavior, and more attention should be paid to meet the increasing health needs of people as their living conditions improve.

The biopsychosocial medical model liberates the human medical thinking mode from the traditional biomedical thinking mode, and promotes a comprehensive and systematic way of thinking to explore the phenomenon of life in a multi-level, multi-directional and three-dimensional way, to master the law of change of the disease, and to correctly deal with the medical problems.

In addition, it expands the research scope of modern medicine, combines social science with natural science, and encourages people to study and solve medical problems from the perspective of social and psychological factors; it enriches the connotation of preventive medicine and promotes the development of public **** health. It is not only the cause of disease analysis, diagnosis and treatment of great significance, but also in the prevention and control of disease and health promotion will play a very important role in guiding.

Bio-psycho-social medicine model is so far more in line with the material dialectics of the medical model. However, with the progress of human society, the development of medical science and the continuous improvement of people's cognitive ability, this model still needs to be perfected, improved, and even updated.