If we all agree that the medical model is outdated, why is it so resilient? This was one of the most insightful questions at the recent thought-provoking workshop for the Rethinking Medicine programme.
It was asked by Chris Van Tulleken, now a well-known media doctor, but back in the day a peer of mine at medical school. It prompted me to reflect more on the nature of the medical model, my own experience of it as a GP, and why it's so pervasive.
How often do we get a chance to think and reflect these days? We are pretty caught up in the doing, performing as the doctors and nurses we have been trained to be. But if you stop and have the luxury to think a bit, it does make you wonder if we are ploughing on with the right sort of 'doing'?
We tend to steer by the guiding lights of evidence-based medicine, well synthesized and simplified from the mountains of research that most of us are too busy, or ignorant, to contemplate. Mostly it comes from clever and ever more sophisticated biomedical insights.
People come to see doctors with problems. They tell their story, the clinician examines them, clinches a diagnosis (perhaps after ordering a test or two) and then prescribes a fix. It's that simple. Occasionally.
Much more often, people come to see doctors with complex stories of dis-ease, or with multiple conditions, many with their roots in the social determinants of poor health.