Word games with medical care – time to simplify

One of the ways medicine plays games with itself is in the provision of names for modes and models of care. Names are used to brand modes of care and perhaps in an unnecessary manner.

Some examples that come to mind include the distinction between palliative care and supportive care. Respectively these terms have come to mean palliation at the end-of-life and palliation through the rest of an illness. At the end of the day the aim is to effectively manage physical, psychosocial and existential issues and symptoms related to an illness regardless of the phase of the illness. The different terms serve to support different political and economic agendas.

Another potential example is the concept of the medical home. The medical home is a model of care designed to provide high quality care through a primary care practice, arguably, as opposed to fragmented care in a specialist system. An alternate way of thinking of the medical home is that it is about having a family doctor. Yes, I’ll acknowledge that the concept is expanded to include team-based care coordination, etc, but the bottomline is that the concept is about good primary care.

Recently in the oncology world the concept of survivorship has become fashionable for research and service delivery. Interestingly a lot of the interventions that are being demonstrated to potentially be of benefit for cancer survivors overlap with those which are of interest to preventive medicine. These include managing diet and weight, activity levels and fitness, and mindfulness. In otherwords both survivorship and preventive medicine are about wellness.

Holistic medicine, the bio-psycho-social model of healthcare and the whole person movement are another example of word-games in medical care.

There are two themes that underpin these comparisons. The first is an emphasis on delivering quality care for the unwell regardless the context of the illness, both in terms of physical setting and the phase of the illness. The second is wellness or being healthy, underpinned by personal empowerment around healthcare decisions. If we can focus on these principles rather than specific silos of thinking that they might support then perhaps we can start to see the forest through the trees. Lets talk about quality of care and wellness.

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