RURAL FAMILY PRACTICE│Vol.3│No.3│November 2018│

How to cite this article

Herrera D. Rural Medical Practice Outside the Biomedical Model. Rural Family Practice. 2018 november; 2(3).

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EDITORIAL

Rural Medical Practice Outside the Biomedical Model

Diego Herrera[a]

a. Saludesa Santo Domingo

Medical practice in different periods of history reveals the determining effect of historical context on medicine. Therefore, medicine as a medical practice cannot be considered independent, or outside, of the social structure.

The dominant economic and political systems throughout history use ideology to defend their interests. What we now call “ideology,” Plato called "false consciousness," which was considered by the philosopher as man’s non-recognition of the "rules" that should regulate their behavior (1). Machiavelli, in the fifteenth century, saw ideology as a distorted perception of human appetites, interests, and judgments: "everyone sees what appears to be, few experience what  really is" (2).

For centuries practitioners of medicine have tried convincing themselves that scientific practice is independent of ideology. Bacon sought a vision of science that was not infected by ideology. This position is very similar to that developed by the positivists and some Marxists who conceive science as neutral (3).

At the time of the rise of Western medicine, the economic and political system was subordinated to philosophy. Greek medicine, although pragmatic and founded on observation, was based on the Aristotelian theory of the four elements.  These elements inspired the Hippocratic theory of the humors, the doctrinal framework of their school.

In the Middle Ages, medicine was dominated by religion. It was believed that disease was a punishment from God for the sins committed, and the only way to heal someone was to pray for God's forgiveness. Medieval doctors were usually priests or religious scholars. Hospitals were often installed in monasteries. Patients were given food and comforted, but little else was done to cure their illnesses. Traditional cures using medicinal plants and potions were seen as witchcraft and outlawed by the Church. (4)

In modern times, Kant proposes reason as a way to justify any pretense of validity for society and also for medicine. Thus, it became imperative to achieve, among other things, a scientific development that allows foreseeing or solving problems through a knowledge based on absolute theoretical truths.

The mastery of science over the individual and society, as well as the power that technology wields, has a great influence on modern medical practice.  Medicine has become a theory of practical procedures derived from scientific knowledge and the exponential development of technology. Its now massive application makes the series of medical tasks an important component of the world of work.

From the ideological point of view of modernity, called "scientific point of view," it is reasonable to think that the mathematization of nature appears as a necessity to give scientific seriousness and certainty to Health Sciences. In Medicine we need something like a matrix of biological knowledge constituted by vertical explanations and causal chains that have formal logic, computer science and strict reasoning, explained through conceptual models.

In the 80s, this discourse turned into alternative health self-care programs that we miscalculate as Primary Care. These programs attempt to overcome biologism and the determinants of the health-disease process. They assume that the health of the community is determined by their consumption conditions.  Therefore, a change in these conditions could prevent all diseases because their interest is not the transformation of life and health, but to maintain a "false conscience," or ideology, that does not endanger the prevailing economic system.

The medical schools are mostly influenced by positivism and the new phenomenology; the formation of critical thinking is relegated in the best of cases to four schematized classes of thought development. There is no interest in training doctors professionally. Instead, doctors are taught to proceed by following a series of guides, protocols and consensuses, created without taking into account the context or the particularities of the patient. We carry out national programs for influenza control, without any contextualization; we seek therapeutic goals of the first world in the third world; we give little value to our historical heritage, and ignore, for instance, the so-called "Latin paradox."

Systems thinking, as part of complex thinking surpasses both positivism and the new phenomenology. It is not based on statistical numbers, but on the study of particularities. These particularities allow for the revealing of the truth of the adaptive conflict.  This adaptive conflict uses disease as a "refuge" in the face of misfortune or personal disgrace that we call suffering, and is not possible using only the scientific point of view.

The task is to find how the organic or functional condition came into being and maintaining permanently the respect the needs and dignity of the person who turns to us. In respecting the dignity and differences of the other person, we find the basis for our own dignity. This principle is magnificently represented in Sydenham's phrase: "No one has been treated by me in a different way than I would like to be treated if I get sick from the same evil" (5).

The Being of people is a historical identity that is configured in the world in the form of a Project. The objective of the doctor utilizing complex thinking is to achieve an understanding of the person through the communicative language and the understanding of the individual's life situation and life in general. The treatments that we negotiate with the patient depend on the philosophical way in which the patient and the doctor conceive the world, in a relationship of continuous exchange.

If the patient conceives themself as a spiritual being and believes that their body can harbor spirits, the disease is an evil spirit and the therapy consists of frightening the spirit. If the patient is conceived as an evolutionary category, that is, as an animal that lives in nature and was created by nature, disease is a disorder that depends on nature and therapy must be natural. If the patient sees himself as a physical and chemical animal, his illness must be treated with physiotherapies or chemotherapy.

Overcoming biologism, positivism, and the new phenomenology, using complex thinking to understand the patients and their suffering and learning to negotiate and individualize treatments is the essence of the art of medicine.

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