The Goals of Medicine


Book Description

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless.




The Nature of Suffering and the Goals of Medicine


Book Description

This is a revised and expanded edtion of a classic in palliative medicine, originally published in 1991. With three added chapters and a new preface summarizing our progress in the area of pain management, this is a must-hve for those in palliative medicine and hospice care. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with metastic cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a mior problem--in little pain and not seemingly distressed--said that even coming into the hospital had been a source of pain and not suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to Dr. Eric Cassell, these are crucial questions, but unfortunately, have remained only queries void of adequate solutions. It is time for the sick person, Cassell believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, Cassell argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient. Dr. Cassell offers an incisive critique of the approach of modern medicine. Drawing on a number of evocative patient narratives, he writes that the goal of medicine must be to treat an individual's suffering, and not just the disease. In addition, Cassell's thoughtful and incisive argument will appeal to psychologists and psychiatrists interested in the nature of pain and suffering.




The Principles and Practice of Narrative Medicine


Book Description

The Principles and Practice of Narrative Medicine articulates the ideas, methods, and practices of narrative medicine. Written by the originators of the field, this book provides the authoritative starting place for any clinicians or scholars committed to learning of and eventually teaching or practicing narrative medicine.




Naturalism in the Philosophy of Health


Book Description

In a series of papers published in the 1970s, Christopher Boorse proposed a naturalist theory of health, mainly based on a value-free concept of ‘biological function’, a concept of ‘reference class’ and the notion of ‘statistical normality’. His theory has profoundly shaped the philosophical debates on the concepts of health and disease. It could even be said that the numerous criticisms of his 'biostatistical theory' are at the centre of what is usually referred to as the debate between ‘normativists’ and ‘naturalists’. Today, the predominant naturalist theory of health is still Boorse’s biostatistical theory. This volume offers the first comprehensive review and critical assessment of the nature and status of naturalism in the philosophy of health. It explores the notion of biological normativity and its relevance for the philosophy of health, and it analyses the implications of the philosophical theories of health for healthcare and the debate on health enhancement. In the first section, several contributions identify the kind of ‘naturalism’ the biostatistical theory belongs to and offer further criticisms or possible modifications, such as the concept of function that is required by this theory, and whether a comparativist approach to health is more relevant than a non-comparativist one. The second section explores natural or biological ‘normativity’ and some possible accounts of health that could be based on this concept. The third and final section focuses on the implications of naturalism in healthcare. 'Goals of Medicine’ is the first paper in which Christopher Boorse ventured toward analysing the implication of his biostatistical theory of health on the practice of medicine, the difficult issue of the goals of medicine and the boundary between treating and enhancing. Other papers in this section critically evaluate Boorse’s account and analyse the importance of a positive concept of health.




Achieving Your Personal Health Goals


Book Description

It is important that each of us understand and communicate our personal health goals in order to maintain good health and receive good health care. We all hope to avoid premature death and disability, participate in meaningful life activities, become more capable and adaptable, and experience a comfortable death. However, each of us defines these goals differently, and we differ in the strategies we choose to achieve them. In this book, the author, a primary care physician and teacher, uses case examples and practical advice to help readers clarify their health goals, understand the kinds of strategies likely to be effective, and understand the health care system in order to get the help they need and avoid unnecessary tests and treatments. The book includes 16 chapters divided into 3 sections, The Goals of Health and Health Care, Obstacles and Challenges, and Achieving Your Health Goals. The first 14 chapters are followed by questions for contemplation or discussion. The book has 256 pages.




The Future of Public Health


Book Description

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.




Goal-Oriented Medical Care


Book Description

The premise of Goal-Oriented Medical Care is that, prior to consideration of strategies, the health care team must understand the patient's personal health goals and priorities. While intuitively obvious, addition of the goal-clarification step changes the focus from problem-solving to goal attainment, forcing a reconsideration of the meaning of health and the purpose of health care. It elevates the role of patients in decision-making, broadens the range of strategies, encourages individualization and prioritization, and creates a conceptual framework for true person-centered care. And while the idea is deceptively simple, it provides a blueprint for the transformation of health care systems trying to adapt to changing health concerns, scientific and technological advances, health and health care inequities, and rising costs. This book was written primarily to introduce goal-oriented medical care to physicians and other health care professionals, but it should be of interest to health care administrators and policy-makers as well.




Graduate Medical Education that Meets the Nation's Health Needs


Book Description

Intro -- FrontMatter -- Reviewers -- Foreword -- Acknowledgments -- Contents -- Boxes, Figures, and Tables -- Summary -- 1 Introduction -- 2 Background on the Pipeline to the Physician Workforce -- 3 GME Financing -- 4 Governance -- 5 Recommendations for the Reform of GME Financing and Governance -- Appendix A: Abbreviations and Acronyms -- Appendix B: U.S. Senate Letters -- Appendix C: Public Workshop Agendas -- Appendix D: Committee Member Biographies -- Appendix E: Data and Methods to Analyze Medicare GME Payments -- Appendix F: Illustrations of the Phase-In of the Committee's Recommendations.




The Nature of Suffering and the Goals of Medicine


Book Description

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years.




Wrong Medicine


Book Description

In exploring these timely questions, Schneiderman and Jecker reexamine the doctor-patient relationship and call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and often clear definitions of what constitutes futile medical treatment.