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Thank you, Dr. Stange, for your insightful essay. Your piece serves as a poignant reminder that the core problem runs deep. Family medicine, as a discipline, was initially established on the foundations of a holistic understanding of health, aligning with the 1948 World Health Organization definition. https://www.who.int/data/gho/data/major-themes/health-and-well-being
Family medicine conceptualized health as the comprehensive integration of physical, social, and overall well-being. Health, in this sense, encompasses the capacity to adapt to changing circumstances within the framework of nurturing relationships with oneself, others, the community, and the wider world.
Unfortunately, family medicine's perception of health directly clashed with the depersonalizing, reductionist, disease-centered biomedical definition. Consequently, family medicine has often been viewed as a counter-culture discipline, marginalized from its inception. This conflict surrounding differing health paradigms has led to the absence of an explicit national definition of health in the United States. https://pubmed.ncbi.nlm.nih.gov/37343061/
Instead, the US healthcare system has appropriated certain aspects of family medicine's language, such as "person-centered care" and even "social determinants of health." These concepts have been commodified within a biomedical model of health. Regrettably, the implicit definition of health within the US healthcare and research realms is biomedical. The healthcare system reimburses based on billing for procedures (CPT codes) related to specific diseases (ICD-10 codes), delivered through isolated clinician-driven visits. Disturbingly, as family medicine has become integrated into larger healthcare systems, it too has been assimilated within the biomedical model, resulting in family medicine's commodification and deconstruction. The biomedical model is fatally flawed. It is incapable of enhancing population health at reasonable cost, much less doing so equitably.
To establish a functional healthcare system, the first step is to define and operationalize what health truly means to us. The National Academies of Sciences, Engineering, and Medicine have provided guidance through their reports on Implementing High-Quality Primary Care and Achieving Whole Health. However, the biomedical model remains deeply entrenched within what Henrich (WEIRDist People in the World, 2020) describes as a WEIRD culture: Western Educated Industrialized Rich Democratic, founded on reductionism. While reductionism can be a powerful tool in medicine and the world at large, it should not be deployed to diminish our humanity or depersonalize care. Creating a functional healthcare system necessitates a restoration of humanity to the concept of health and more broadly, health to humanity.