Biomedical model: what is it and what ideas about health is it based on?

What is the biomedical model and on what philosophical foundations about health is it based?

Health is one of the great assets of every human being. We treasure it and strive to preserve it, despite the passing of the years and the adversities on the body and mind that are associated with living.

However, defining what health is is not easy. Different perspectives have been postulated for this purpose, most of them coming from philosophical thinking on the ontology of man and woman.

The biomedical model is the most traditionalforged in the heat of the positivism of the eighteenth century. In this article we will define its most essential aspects, as well as its impact on how we understand health and its care.

What is the biomedical model?

The human being is very complex, so any attempt to reduce it to a simple definition is doomed to fall into reductionist biases. The physical, psychological and social dimensions that underlie each one of us are evident; and that build the fundamental plots of our organic, mental and interpersonal reality. All of them, in their virtually infinite way of interacting, shape the whole person.

This fact is obvious when we reflect on our nature, but less so when we address one of its most fundamental aspects: health. In this area, and for many years, medicine has been based on the most absolute of Cartesian dualisms.. Thus, body and mind would end up being understood as stagnant and unconnected entities, governed by different logics and lacking any point of contact.

This is the epistemological and philosophical basis of the biomedical model of health, for which health is limited only to the observable aspects of the organism. As a consequence, all diseases could be explained through anatomical or functional changes in the tissues, or the action of external pathogens. external pathogens. Their identification would be based on objective and quantifiable signs, while the rest of the factors that could mediate would only be secondary epiphenomena.

The biomedical model understands that any pathology has a single cause, and that since this is of a purely physical nature, the action taken to resolve it will involve surgical or pharmacological manipulation. To achieve this purpose, two basic strategies would be used: medical diagnosis (through techniques that explore the integrity or function of the different organs and systems) and intervention (through the modification of the anatomical structure or the reestablishment of the chemical balance).

What are the positive aspects of the biomedical model?

The biomedical model has a positivist character, which is based on the experimental method to determine the springs related to the disease process. For this reason, it has made it easier to draw useful explanatory hypotheses on the functioning of the body and the pathologies that threaten it throughout life. This knowledge has made it possible to generate curative treatmentscontributing in a relevant way to the recovery of health when it has been lost.

The survival of this biomedical model for centuries is eloquent proof of the benefits it has brought. However, a number of shortcomings are now recognized that have led to qualitative changes in the care offered to the sick.

What are the negative aspects of the biomedical model?

The biomedical model was the dominant perspective from the eighteenth century until well into the twentieth century.. It is honest to acknowledge its contribution to the advancement of knowledge about the organic factors related to health, which are very relevant, although insufficient to define it integrally. It is not in vain that the World Health Organization (WHO) described it, in the preamble to its constitution (1946), as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Some of its limitations as a theoretical model for health will be discussed in more detail below.

1. Focus on physiological aspects of health

In line with the definition proposed by the WHO, health should be understood as a multifaceted phenomenon in which physical, psychological and social components are expressed in complex and intimate interaction. Thus, a person could not be considered "healthy" when he or she lacks physical pathologies but suffers from emotional problems, or is isolated from his or her social and/or cultural environment.

This way of understanding health provides an explanatory framework from which to understand current evidence, such as the fact that pathologies of the body motivate a process of affective/emotional adaptation or that loneliness reduces life expectancy. The emphasis circumscribed to the organic would, on the other hand, obviate potential causes and consequences of some of the most common problems faced by society.

The biomedical model understands the organic as the only variable worthy of consideration, orienting all diagnostic and therapeutic resources in this direction. This way of proceeding is somewhat reductionist with regard to current knowledge on human health..

Focus on the cure of disease, but not on the promotion of health.

The biomedical model is efficient in detecting a disease when it is already present, including in the best of cases tertiary prevention (avoiding worsening or physical complications), but neglecting primary prevention (which extends to the whole of society to reduce the prevalence or incidence of a health problem) and secondary prevention (which concentrates on those individuals who are at risk or vulnerable).

3. Restriction of the patient's decision-making

The biomedical model attributes to the health professional an omnipotent role in the whole process, reducing the active participation of the sick person. This passive role sees the patient as a helpless being in the face of the adversities he or she has had to live through, and who would act as a mere recipient of the patient's treatment.and who would act as a mere receptacle for the therapeutic procedures decided upon for him/her. It is, therefore, a paternalistic prism.

We now know that stimulating decision making in the sick person and his/her family promotes a greater sense of control over the health situation, which has a positive impact on therapeutic adherence and prognosis.This has a positive impact on therapeutic adherence and on the prognosis of the pathology. Besides, obviously, on motivation and emotion. Therefore, one of the roles of caregivers is to provide information about the disease and the options available for its treatment, encouraging a thorough and consensual choice.

4. Life expectancy and quality of life

The biomedical model has as its fundamental purpose the maintenance of life, although it does not pay equal attention to the stimulation of its quality. Quality of life is a complex dimension that includes the integration of physical (body function, autonomy, pain, etc.), psychological (emotional well-being, satisfaction with life, etc.) and social (personal relationships, contact with the environment, use of care resources, etc.) aspects, which are also linked to cultural and subjective aspects.

The emphasis on the organic aspect makes it possible to increase life expectancy, but does not offer any solution to improve the quality of life.but does not offer any solution to improve its quality beyond the maintenance of function. In fact, such an attitude has led to certain iatrogenic consequences in the past, which today we are trying to avoid (such as therapeutic over-zealousness when trying to prevent the onset of death in terminally ill patients). Although it is important that life should last, it should not be limited to a simple accumulation of years.

5. Emphasis on labeling

The diagnosis of a health condition, especially in the psychological realm, involves the process of abstracting a complex expression to place it within the narrow range of clinical descriptions contained in manuals designed for this purpose. Nevertheless, the reality of the problems that compromise psychological integrity tends to impose itself on any attempt of classificationThe diagnosis is relevant to delimit the boundaries of the diagnosis.

Diagnosis is relevant to delimit a phenomenon requiring intervention, as well as to facilitate communication between different professionals, but it can also be a heavy burden for the person receiving it. It is therefore crucial to weigh the pros and cons that may result from it, and to prioritize efforts in addressing the individual symptoms of each person. The diagnostic emphasis is an inheritance from biomedical traditions, the usefulness of which in the field of mental health is always subject to constant debate.

The biopsychosocial model: a path to integration

The biopsychosocial model of health starts from the weaknesses that have been highlighted for the biomedical perspective; and aims to bring together the biological, the social and the psychological into a coherent whole.. It is a perspective from which the humanization of all health interventions has been advocated, promoting an integral perception of the person not only in the context of his or her physical vulnerability, but also of his or her own individuality and particular needs.

Attention to emotional life, motivation and thought, as well as to family and community ties, has provided a broader framework for understanding health and disease. This overview, which involves the synergistic effort of multiple professionals aimed at covering all spheres of the human being, allows for a more complete care along the way to recover health and well-being.

Bibliographical references:

• Havelka, M., Lucanin, J.D. and Lucanin, D. (2009). Biopsychosocial Model - The Integrated Approach to Health and Disease. Collegium Antropologicum, 33(1), 303-310.
• Wade, D. and Halligan, P. W. (2005). Do biomedical models of illness make for good healthcare systems? British Medical Journal, 329, 1398-1401.