Kleinman A, Eisenberg L, Good B
Ann Intern Med. 1978 Feb;88(2):251-8. doi: 10.7326/0003-4819-88-2-251.
Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.
诸如患者不满、医疗服务获取不平等以及成本不断攀升等重大医疗保健问题,似乎已不再适合用传统生物医学方法来解决。源自人类学和跨文化研究的概念或许能为识别需要解决的问题提供一个替代框架。本文阐述并举例说明了一系列有限的此类概念,包括疾病与病患之间的根本区别,以及临床现实的文化建构概念。这些社会科学概念可发展为直接应用于临床实践和教学的策略。本文概述了其中一种策略,作为一门能够将文化人类学概念转化为临床实用语言的临床社会科学的示例。在医学教学和实践中实施这种方法需要更多课程和资金方面的支持。