Thursday, April 23, 2009 4:20
Posted in category General Health

What people do about their health depends more on what needs they feel they have than upon what they know. So the best doctor-patient relationship stems from a real understanding of the patient’s needs and perceptions of the situation rather than from a doling out of knowledge from one who ‘knows’ to one who ‘doesn’t’. So it is that in the medical profession as currently organized health-directed needs can be coped with but health-related needs can’t. As we move away from the essential interventions of crisis medicine towards prevention, the importance of attaining health diminishes for the individual and other more pressing everyday needs take over; doctors, because they are health-directed, appear to be of less value because what is needed is someone who is health-related. Both epidemiological and clinical studies show that there are almost no areas of human behaviour that are not related to health, so in this sense preventive medicine takes in all of a person’s life; yet doctors are trained to see the person through a narrow slit-that afforded us by his or her symptoms. A lot of health education has tended, often with moralistic overtones, to convert health-related to health-directed behaviour. The answer to the prevention of diseases is not to medicalise life but to be more aware of the un-healthful aspects of it and to modify them.

Unfortunately, the sickness-centered health-care system of the western world has produced a love-hate relationship between professionals and the end users. Few people choose to go to their doctor unless they have what they perceive to be a problem. This makes the medical profession moppers-up of ailments and dealers in ‘problems’. Doctors and the allied health professions are thus seen as an unfortunate necessity that one keeps away from until absolutely necessary.

This kind of thinking does nothing to generate positive preventive health behaviour. It is an ironic but predictable conclusion to say that doctors are almost the worst people to be saddled with the responsibility for preventive services. What is needed is a new profession which would be much less illness-centered and much more alive to the realities of the needs of the community in which they work. Individuals know what is important to them and their community, yet so much of the time preventive efforts have tried to superimpose some quite alien behaviour or perception on them.

What appear to work better are programmes aimed at groups, such as teenagers, pregnant mothers, the elderly or whatever. Within these cohesive groups, peer-group pressure can be used creatively to implement changes, and change is more likely to occur as one piece of preventive behaviour interacts with others to produce a lifestyle that tends to prevent disease rather than produce it.


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