Tyreman Stephen
British School of Osteopathy, 275 Borough High Street, London, SE1 1JE, UK.
Med Health Care Philos. 2006;9(3):285-91. doi: 10.1007/s11019-006-9006-6.
This paper explores causation in the context of health care practice, in particular, primary care. Causation in health care is necessarily premised on the concepts of disease and illness and the ways they are deviations from health. The paper reviews and broadly categorises concepts of illness most commonly found in the literature in terms of the biomedical, biopsychosocial, and agency models. It is argued that although each model has its place in the gamut of health care practice, primary care implicitly or explicitly uses an agency model most frequently. By explicitly acknowledging the role that patients' values and expectations have in utilising their physiological, psychological and social capacities to live their lives, clinicians can gain a clearer understanding of how a situation has come about and why it has become a health problem for the patient.
本文探讨医疗保健实践背景下的因果关系，尤其是初级保健中的因果关系。医疗保健中的因果关系必然基于疾病和病患的概念以及它们偏离健康的方式。本文根据生物医学、生物心理社会和能动性模型，对文献中最常见的病患概念进行了综述并大致分类。有人认为，尽管每种模型在医疗保健实践的范围内都有其作用，但初级保健最常隐性或显性地使用能动性模型。通过明确承认患者的价值观和期望在利用其生理、心理和社会能力来过生活方面所起的作用，临床医生可以更清楚地了解一种情况是如何产生的，以及为什么它会成为患者的健康问题。
