Mechanic D
Rutgers University, New Brunswick, NJ 08903, USA.
Soc Sci Med. 1995 Nov;41(9):1207-16. doi: 10.1016/0277-9536(95)00025-3.
The almost exclusive dependence on the diagnostic disease model limits addressing the burden of illness and disability typically seen in primary medical care. With aging of populations and increasing prevalence of chronic disease and disability and behavioral disorders, new approaches to patient assessment and intervention are needed to extend traditional models. Using illness behavior as a point of departure, I examine the disability process and the types of considerations relevant to promoting function and maintaining patients' quality of life. At the individual level, alternatives include modifying impairments, increasing patient motivation and encouraging helpful attitudes, teaching coping strategies, identifying helpful assistive devices, educating family members and employers and providing support. A broader view also makes clear that varying aspects of the disability process are appropriate issues for social policy and environmental remediation. In examining various examples of the disability process, the paper focuses on self-appraisal and illness behavior and the way social movements help to define and redefine conceptions of illness and disability. Recognizing that the kinds of changes discussed will not come easily, the paper concludes with a discussion of trends encouraging broader practice orientations and the types of interventions that can be helpful in encouraging and reinforcing such developments.
几乎完全依赖诊断疾病模型限制了对初级医疗保健中常见疾病负担和残疾问题的应对。随着人口老龄化以及慢性病、残疾和行为障碍患病率的上升，需要新的患者评估和干预方法来扩展传统模式。以疾病行为为出发点，我研究了残疾过程以及与促进功能和维持患者生活质量相关的各类考量因素。在个体层面，替代方法包括改善损伤、增强患者动机、鼓励有益态度、教授应对策略、识别有用的辅助设备、教育家庭成员和雇主以及提供支持。更宏观的视角也明确表明，残疾过程的不同方面是社会政策和环境整治的恰当议题。在审视残疾过程的各种实例时，本文聚焦于自我评估和疾病行为，以及社会运动如何有助于界定和重新界定疾病与残疾的概念。认识到所讨论的这类变革并非轻而易举就能实现，本文最后讨论了鼓励更广泛实践取向的趋势以及有助于推动和强化此类发展的干预类型。
