Health
What?
- Health concerns the well-functioning of a living organism as a whole. Its parts serve the activities of the whole person. The curriculum’s classical account describes it as bodily excellence: not just the absence of a problem, but a positive good to maintain.
- Three accounts considered here are bodily excellence, the absence of disease, and physical, mental and social well-being. Each raises questions about what medicine should restore or preserve and how health differs from flourishing.
So What?
- Prudent clinical judgment requires an understanding of the good being pursued. Health belongs to the whole living person; specialization can serve that aim while making it easier to lose sight of the patient beyond an organ or procedure.
- Treatment and prevention raise questions about medicine’s responsibilities and limits. Symptoms, daily functioning and meaningful activity deserve attention, but the power to perform an intervention does not by itself establish that it serves health or belongs within medicine’s proper role.
Now What?
- Discuss what health means with colleagues and patients, including people living with chronic, incurable conditions. Make the intended good of care explicit and ask how your training or practice keeps the health of the whole person central.
- Reflect on your own habits and how clinicians model health. Consider nutrition, movement, rest and other relevant supports within care. Ask how medicine can assist the body’s capacity to heal and who shares responsibility for helping people attain and maintain health.
Clinical Case
You are a fourth year medical student rotating in a cardiology elective. You wake up early for your first morning of cath lab appointments. You are excited by the prospect of working in a fast-paced urgent environment. When you arrive at the hospital, you greet the attending invasive cardiologist, Dr. Lee. As she is walking you through the day’s schedule and reminding you of sterile environment precautions in the lab, you ask her about her decision to go into cardiology. “I really like the excitement of emergency cardiology and the fact that I’m the terminal level of care for urgent cardiac cases,” she says as she opens her second Pop-Tart of the day. “Breakfast,” she says before preparing for the busy morning. Her words resonate with you as you are drawn to the excitement and glamor of big hospital medicine and being able to do complex procedures.
However, as the morning progresses, you notice that most of the patients needing cardiac procedures have many comorbidities. All four of the morning appointments were severely overweight and three of them were type 2 diabetic. You ask Dr. Lee if anything could have been done to prevent these patients from ending up in the cath lab. “Maybe, if they had kept their weight down and learned how to deal with stress and lifestyle issues, they could have been more healthy,” she says bleakly. “But I don’t get paid to see healthy patients, and besides, it’s not my job. I place stents and do fluoroscopies. You’ll get used to seeing lots of these types here.” She is cut off by a notification of an emergent cath lab activation. Finally, a real emergency.
On your way home from the hospital you reflect on the day, wondering if there was really nothing these people could have done to prevent cardiovascular disease and whose job it is to help people like this attain and maintain health.
Discussion Questions
- What does the body’s capacity for homeostasis and healing suggest about health?
- Who should encourage attaining and maintaining health? Does medical education prepare physicians for this responsibility, and do professional incentives support it?
- How does well-functioning of the parts relate to that of the whole?
- What place do dietetic measures and mental health have in medicine? What responsibilities and limits follow from the physician’s role?
- How do restoring health and relieving suffering relate? Does medicine assist the body’s healing, replace it, or both?
- What can health mean for a person living with incurable disease?
Sources
Sources: LearnWorlds lessons and the earlier Canva one-pager.