Biomedical Model

3 March 2017

Firstly the “biomedical model of health” (no hyphen) is sort of open to interpretation and not always defined the same way. And generally speaking a biopsychosocial model is almost universally used. But when I think of a biomedical model is it practicing medicine to “fix” things with the view that medical problems are organic (physical) without considering anything else. Some times it is referred (in an insulting way) to as the biomechanical model.

To some extent that is true since a biomedical model tends to view the human body as parts of a machine and when person is ill it means something has broken but once fixed the patient is restored to heath. But medicine simply is not practiced like this because it is problematic, flawed, and not pragmatic. The primary criticism is that people are not machines, problems may be psychiatric, and problems may involve multiple factors. As we learn more and more it is clear that mood and mental health can physically destroy a person.

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Actually is something called a conversion disorder meaning that anxiety or something else is “converted” (unknowingly) into physical symptoms. And there are other somatoform disorders, and Munchausen. I’m in psychiatry and that is the field of medicine to most embrase and more holistic and biopsychosocial model. Many medical practices for many problems have psychiatrists on staff. Psychiatrists are also one of a few specialists that can become specialists in pain management and other things. The best example where a biomedical model fails is in pain.

Here is a hypothetical situation- a man visits his doctor complaining of lower back pain. The doctor orders tests- they are all fine. The patient has a history of insomnia and depression. There is a significant family history of insomnia, anxiety, depression, and suicide. No personal history of substance abuse but both of his grandfathers (now dead) were barbiturate addicts. Despite the fact that imaging shows no sign of problems (but his physical exam STRONGLY indicates there is pain. The doctor does several invasive procedures. All conservative pharmacological treatment is tried (gabapentin,

Lyrica, tramadol, ketoporfen, acetaminophen, cyclobenzaprine, Soma, Cymbalta, amitriptyline) and referral to pain management is made. [Note: in reality many people with very real pain will have normal imaging] Once there Norco (hydrocodone/acetaminophen) 5/325 1 tab four times a day is prescribed. It provides a rapid improvement but over four months his medications have become OxyContin 30 mg twice daily, 4 mg of hydromorphone for break threw pain, 100 mg of Celebrex daily, 3 mg of Lunesta, Soma 350 mg four times a day, and clonazepam 2 mg twice daily.

With that he reports (at least for now) he that is pain is only minimal. However he is more and more disabled and has lost much of his function. So even as doctors try to control the pain and have used all basic medical things he is not better. Now if he is evaluated by a psychiatrist, he goes for cognitive behaviour therapy (CBT), and a much greater multidisciplinary approach is used he gets much better and only needs 10 mg of OxyContin twice daily, he only uses the Soma as needed, the clonazepam is now 0. mg, and he is taking Zoloft (sertraline) for anxiety and depression. Simply put this person did have true pain but it was aggravated by his anxiety and depression. The opioids, clonazepam, and Soma did help the pain but he developed pseudotolerance to their effects meaning his depression and anxiety were better on the drugs and once that high was gone he needed more. If he would have been evaluated on his physical health, mental health, family life, friends, stability and so on it would have been clear that pain was not the only factor.

Often people say that western medicine is not holistic but that has changed a lot Below are a few of my favourite quotes about medicine that you may find helpful: The physician should look upon the patient as a besieged city and try to rescue him with every means that art and science place at his command. -Alexander of Tralles (a preeminent early Greek physician). The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated. -Plato

Treat the patient, not the Xray. – James M. Hunter A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world. -Harvey Cushing (neurosurgeon, pioneer of brain surgery). Never forget that it is not a pneumonia, but a pneumonic man who is your patient. -William Gull (Famous British physician to Her Majesty Queen Victoria who established the term anorexia nervosa).

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