Kenen R H
Department of Sociology and Anthropology, Trenton State College, NJ 08650-4700, USA.
Soc Sci Med. 1996 Jun;42(11):1545-53. doi: 10.1016/0277-9536(95)00248-0.
In the past two decades, the medical model has extended its jurisdiction to cover a new medical entity-the at-risk health status-which is frequently accompanied by what I call a diagnostic invitation and the 'gift' of knowing. In cases, however, where the diagnosis may only reaffirm the risk but can provide no cure, the value of the 'gift' of knowing is questioned. The at-risk health status also can: (1) develop a symbiotic relationship with diagnostic technology, (2) become an organizing principle in individual and social behavior and (3) provide new tasks for clinical medicine. The perceived cost effectiveness of preventive measures, combined with the desire to use high-technology medicine, to achieve newly expanded definitions of health make it likely that the concept of the at-risk health status will be integrated into whatever health care plan is finally enacted for the United States. In light of the possible negative, as well as positive, effects of at-risk health labelling, American society needs to establish standards for the diagnostic invitation as a gift of knowing especially when the line between prevention and overuse is not always clear.
在过去二十年中，医学模式已将其管辖范围扩大，涵盖了一个新的医学实体——健康风险状态，这种状态常常伴随着我所说的诊断诱因以及知晓的“馈赠”。然而，在某些情况下，诊断可能只会再次确认风险，却无法提供治愈方法，这时知晓的“馈赠”的价值就受到了质疑。健康风险状态还可能：（1）与诊断技术形成共生关系，（2）成为个人和社会行为的组织原则，（3）为临床医学带来新任务。预防措施的成本效益被认为很高，再加上人们希望使用高科技医学来实现对健康的新扩展定义，这使得健康风险状态的概念很可能会被纳入最终为美国制定的任何医疗保健计划中。鉴于健康风险标签可能产生的负面和正面影响，美国社会需要为作为知晓馈赠的诊断诱因制定标准，尤其是在预防和过度使用之间的界限并不总是清晰的时候。
