Unidimensional Approach to Medicine: Why it Isn’t Working

From a global perspective, a multidimensional approach to health and wellness has long been considered the gold standard for both diagnosing and treating physiological and psychological illnesses or disease. Even the most widely used definition of health, which comes from the World Health Organization (WHO), defines health as being “a complete state of physical, mental, and social well-being” (Gurung, 2014, p. 6). However, the United States focuses the majority of its interventional programs and healthcare management around the traditional medical model of health – a unidimensional approach that provides a simple black and white definition of health in terms of simply lacking disease. According to Shi & Singh (2009), the medical model “emphasizes clinical diagnosis and medical intervention in the treatment of disease or its symptoms. Under the medical model, health is defined as the absence of illness or disease. The implication is that optimum health exists when a person is free of symptoms and does not require medical treatment; however, it is not a definition of health in the true sense but a definition of what is not ill health” (p. 28). The efficiency of the medical model in health is highly debatable and has proven to be ineffective in managing the overall health and wellness of the American population thus far. “Many of the peculiarities of this system can be traced back to the beliefs and values underlying the American culture. The delivery of health care is primarily driven by the medical model, which emphasizes illness rather than wellness. Even though major efforts and expenditures have been directed toward the delivery of medical care, they have failed to produce a proportionate impact on the improvement of health status” (Shi & Singh, 2009, p. 46). As we have learned throughout this semester, assessing health from a multidimensional approach is far more practical, especially given the complexity of health and health-related behaviors. Still, much of the contemporary model of health in America is still based primarily on the medical model of health for a number of reasons.

For instance, one of the key explanations that Americans rely solely on the medical model is that have had little to no exposure to other medical models of practice. It’s human nature to stick with what is comfortable and changing behavior or perspective is often a difficult and tedious process. Considering that both psychologists and medical professionals have long developed interventions and treatment programs around the medical model, primarily because it centers around what they’ve learned both in school and in clinical practice, it’s difficult to move away from the medical model as the accepted norm for managing health. As Gurung (2014) mentions, there are three main obstacles that prevent health-related interventions from reaching the clinical populations they have been designed for: “(1) researchers not always understanding the clinical applicability of their basic research; (2) a reluctance of clinicians to accept the value of their basic research; and (3) various institutional-level constraints such as the lack of time, training, or funding” (p. 435).  All of these become problematic in approaching health from an alternate perspective because the lack of knowledge or evidence drives enough motivation for change. For example, both training programs and continuing education for health practitioners don’t generally educate on the biopsychosocial approach health, making the idea seem even more unfamiliar or accepted. “Only a few existing programs provide the necessary training to facilitate the development of health collaborations, and this is another key training area for the field to incorporate” (Gurung, 2014, p. 435). Similarly, since the biopsychosocial approach is relatively new in terms of research and practice in the United States, despite being around for centuries in other cultures around the world, there is just not enough evidence not clearly support or influence professionals to transition to the biopsychosocial approach. Finally, healthcare professionals are reluctant to move away from the current medical model, even when they strongly believe in the biopsychosocial approach to health because of the financial burden it places on both themselves and their patients.

Many of the biopsychosocial approaches to health care and management often are reimbursed by insurance under the current medical model of health and billing becomes problematic with the limited availability of medical codes that are acceptable for what insurance sees as unnecessary, experimental, or alternative treatment options. For example, there are six codes that clinical health psychologists are permitted to use and only certain health plans accept all six of the codes. Medicare, for instance, accepts only five of the six CPT codes for insurance reimbursement (Gurung, 2014). “Not being reimbursed by insurance companies has been one of the biggest reasons for not enough attention being paid to psychological factors and treatment – most patients cannot afford to take care of their mental or physical health if their insurance refuses to pay for the services they need; if health providers do not get paid, they cannot afford to conduct research” (Gurung, 2014, p. 437).  Also, the diagnostic codes for mental illness are subjected to the scrutiny in a similar manner as CPT codes. Take the treatment of mental illness, for example. According to McLeod (2013), “psychiatric diagnostic manuals such as the DSM and ICD (chapter 5) are not works of objective science, but rather works of culture since they have largely been developed through clinical consensus and voting. Their validity and clinical utility is therefore highly questionable, yet their influence has contributed to an expansive medicalization of human experience” (para. 38). Assessing and diagnosing patients under psychological or psychiatric care also becomes an issue in terms of credentialing, which can vary state by state, and ethical concerns have been raised about psychology professionals both diagnosing and treating patients without a traditional medical license. Although there is increasing evidence of the effectiveness of the biopsychosocial approach to medicine and health, there likely won’t be any advancement in moving the healthcare system of the United States over to a biopsychosocial approach until many of the above issues have been formally addressed and regulated.

Aside from the limited exposure to the biopsychosocial model in terms of professional utilization, the American public will likely remain reluctant in accepting a multidimensional approach to health for additional reasons outside of the current system of healthcare. For starters, the public overall lacks general knowledge in proper management or coping skills in dealing with health. Most of the information that is accessible to the public are both overwhelming and confusing, and many health reports provide conflicting information. Take the question of “what is the best diet?” for example. It has been ingrained into us from a young age that in order to be “healthy” we need to both eat right and exercise regularly. However, this concept often brings up more questions than it does answers. For instance, what is healthy to eat? What is a balanced diet? How much and when should I eat? How much should I exercise? What type of exercise? The questions are nearly endless. For those looking to change health behaviors, such as diet or exercise, often look for answers to the questions above. However, it’s likely to cause more confusion since there is no consensus or definitive evidence that constitutes right or wrong answers in this specific example. This becomes more evident in reference to the difficulties in defining the term health, as there are too many aspects to account for defining optimal health, making it challenging despite the growing number of theories regarding health and wellness.

Lastly, the importance of practicing health behaviors is, unfortunately, deficient within the modern American culture. As I mentioned earlier, both lifestyle choices and behaviors are among the chief determinants of health, however initiating or activating behavioral change is extremely difficult to achieve and maintain over time. It’s human nature to be uncomfortable with self-awareness and often resistant to acknowledging their own unhealthy or negative habits that may contribute to health. Changing over to a biopsychosocial approach “would require fundamental change in how Americans view health. It would also require individual responsibility for one’s own health-oriented behaviors, as well as community partnerships to improve both personal and community health” (Shi & Singh, 2009, p. 47). Once again, the lack of biopsychosocial approaches to interventional health behavior contributes to the minimization of healthy behaviors or practices and not all practitioners are sold on solely a biopsychosocial approach. “Surprisingly, not all parts of the scientific community saluted the importance of health behaviors, a controversy in the field of health referred to as the great debate” (Gurung, 2014, P. 423). Furthermore, the American culture has become increasingly sensitive about discussing health behaviors as to not offend others around them and there is limited knowledge of the health disparities affecting the majority of the population in one way or another.

Still, despite the number of obstacles still left to overcome, the biopsychosocial approach to medicine and health is slowly gaining momentum in the United States.  As more patients are becoming increasingly frustrated with American health care practices under its current standards, Americans are considering alternative forms of treatment as an option for managing their health, including holistic medical practices and therapies focused on the mind-body connection. It’s likely that as the field of health psychology continues to expand while health care in the United States declines, both medical professionals and their patients will be more willing to change their opinion on the biopsychosocial approach to overall health.

 

References:

Gurung, R. A. (2014). Health Psychology: A Cultural Approach (3rd ed.). Belmont, CA: Wadsworth.

McLeod, S. A. (2014). The Medical Model. Retrieved on February 26, 2016, from http://www.simplypsychology.org/medical-model.html

Shi, L. & Singh, D.A. (2009). Essentials of the U.S. Health Care System (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

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