Archive for the 'A Country Doctor Reads' Category

Medicalization and Demedicalization in US Healthcare

“Admission Diagnosis: Causa Socialis”

In my training in Sweden it was not unusual to admit patients to the hospital for social reasons: An elderly person who could no longer manage at home, a person whose social network fell apart, and so on.

“Social reasons”, Causa Socialis, was a legitimate diagnosis (Swedes used more Latin than Americans, at least back then). And it was used with only mild grumbling. There was a clear understanding that the hospital was an important part of the social safety net. And, after all, it was ultimately tax dollars that paid for both medical and social services in the community.

In this country, these two types of services have little to do with each other. That is a problem.

For issues that could be either medical or not, Americans have a Newspeak vocabulary. I write frequently about “medicalization”, where for example more or less normal aging processes (wrinkles, osteopenia, low testosterone) become diseases.

The New England Journal of Medicine recently published a piece about the opposite term, “demedicalization”, exampled by a homeless, mentally ill patient who came to harm because he didn’t have a medically appropriate admission diagnosis.

Demedicalization

Demedicalization is the transformation of problems formerly understood to be medical in nature into problems understood to be nonmedical.

Like its opposite, medicalization, demedicalization occurs at multiple levels, ranging from the conceptualization of etiology to the understanding of whether interventions for problems are appropriately medical or nonmedical.

Many disadvantaged people still view modern hospitals as safe havens, like mountaintop monasteries or old fashioned charity hospitals, but they really aren’t anymore.

My thoughts often return to the unsettling, upsetting if you will, fact that societal, cultural, public health or general life problems are “medicalized” when there is money to be made and “demedicalized” when there is not. Do the megahospitals really have tighter operating margins than the two older kinds of institutions they replaced?

Will Technology Keep Us From Thinking?

The New York Times quotes Plato’s play Phaedrus to make a point about Facebook’s use of data. They make the claim that “Technology promises to make easy things that, by their intrinsic nature, have to be hard”.

In the play, a wise king, Thamus, is offered the art of writing by the god Theuth.

The art of writing, Theuth said, “will make the Egyptians wiser and give them better memories; it is a specific both for the memory and for the wit.”

But Thamus rebuffed him. “O most ingenious Theuth,” he said, “the parent or inventor of an art is not always the best judge of the utility or inutility of his own inventions to the users of them.”

The king continued: “For this discovery of yours will create forgetfulness in the learners’ souls, because they will not use their memories; they will trust to the external written characters and not remember themselves.”

It struck me how this analogy is also perfectly applicable to the new technologies entering the field of medicine, from EMRs with “Decision Support” to Artificial Intelligence.

Just like there are store clerks who can’t make change (for customers who still pay with money) or school children who can’t multiply without a calculator, will the doctors of the future be helpless if dislocated from the propping up we are now starting to expect should they ever have to practice in a natural disaster, remote area or mass computer hacking situation?

(P.S. This reminds me of something I read in The Lancet years ago. They tried to coin McCoy’s Syndrome for when Star Trek like doctors rely too much on technology.)

A Country Doctor Reads is Moving

When I started blogging I put my random reads on a separate blog. After much pondering I have decided to bring both blogs under one roof. So from now on I’ll put both kinds of posts on A Country Doctor Writes.

Older posts from A Country Doctor Reads will remain as an archive at their original address:

http://acountrydoctorreads.wordpress.com


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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