Question

how can we explain the paradigm shift that has led to a deemphasis of the medical model and an emphasis of the healthcare model

Answer 1

Deemphasis of medical model:

Changes in medical practice caused by both the growing incorporation of technology and new social demands appear to suggest a special moment in the history of contemporary medicine. However, can we really say that we are experiencing a crisis period in the prevailing medical model and the emergence of a new biomedical paradigm? In the course of this article we seek to respond affirmatively to this question, considering the emergence of bioethics as a strong indication of just such a situation.

The term paradigm was introduced into philosophy by Kuhn in his essay The Structure of Scientific Revolutions, published in 1962, shedding great light on the history of sciences. According to Kuhn, paradigms are "universally acknowledged scientific achievements which, for some period of time, provide model problems and solutions for a community of practitioners of a given science.In such periods of scientific development, which he calls 'normal science', the conceptual framework of a discipline (i.e., its paradigm) remains invariable and scientists are occupied in solving its problems based on the unchallenged reference of the prevailing paradigm.

Yet no matter how long these periods may last, they are not eternal, since from time to time scientists produce results that contrast with consolidated theories, thus leading to problems that cannot be solved within the prevailing paradigm. However, Kuhn emphasizes that such problems, or 'anomalies', do not necessarily lead to a paradigm shift. Yet as such anomalies accumulate, Santos (1989, 1994), in turn, in analyzing the crisis of modernity and its epistemological and societal paradigms, introduces the term paradigm, characterized "by the reconceptualization of existing science as a new science, the outline of which is barely visible" (Santos, 1989: 148). In fact, a transition period means that the prevailing model or paradigm has failed to provide answers to given problems, although its replacement is not fully established. Thus we feel that the use of the paradigm concept sheds light on the current stage of philosophical reflection concerning medical practice.

Such paradigm changes in the sciences were also observed in late 18th-century medicine. As suggested by Foucault, during that period medical research began to correlate diseases and their signs and symptoms with anatomical lesions and to define them as "a system of analytical classes in which the element of pathological decomposition was the principle for generalizing morbid species" (Foucault, 1994:150). From that point on, a conflict was established between two figures in medical know-how: classificatory medicine and anatomo-pathological medicine. It is interesting to note that precisely during this period of medicine the philosophical problems were the center of attention for medical debate (Wulff et al., 1995:18). As Kuhn explains:

Once this state of insecurity has been overcome, the emerging paradigm adds more and more scientists and establishes a new period of normal science. In medicine, this new phase was characterized by technical and scientific progress, which was increasingly successful in pursuing and establishing the cure for diseases as its main purpose. Throughout this period of 'normal science', ethical issues were limited to the sphere of Hippocratic medical ethics

Such determination in curing diseases and prolonging human life through advances in medical knowledge meant that beginning in the 1970s there emerged new problems that failed to find adequate answers within the Hippocratic ethical model. In the past, when physicians could do little for their patients, there were no major ethical concerns beyond those prescribed by Hippocratic tradition. However, ethical 'issues' could no longer be ignored when it became possible to transplant vital organs from one person to another, diagnose congenital anomalies in utero, and prolong the lives of incurable patients.

The emerging ethical questions in medical practice indeed appear to indicate that the traditional medical paradigm has been challenged on the basis of a philosophical reflection that we see as a moment of paradigmatic instability, justifying the pertinence of this debate on the process of metamorphosis in medical ethics.

In the opinion of Pellegrino (1995), this pertinence is justified by the following:

1) Medical ethics, like medicine, is a synthesis of theory and practice, and the quest for solutions to practical moral decision-making problems is thus totally dependent on the conceptual framework used to define what is right and wrong, good or bad.

2) Physicians should acknowledge that philosophers and philosophical theories have exerted a powerful influence on the change in medical ethics; nonetheless, the task of ethical analysis and reflection should not be reserved exclusively for philosophers or jurists.

3) Physicians should be aware of the philosophical arguments employed by their own colleagues when they defend drastic changes in medical tradition.

Of the issues listed by the author, the one pertaining to practical moral decision-making problems may be most deserving of our attention. After all, medicine has been seen as a science that grows on the basis of isolated or pure facts, and one that is thus in a neutral position vis-à-vis value issues (Guillén, 1995: 192).

However, the development of science and in particular that of life and health sciences in recent decades has established a new scientific configuration. Science has literally become techno-science, that implications increasingly independent from the absolute principles shared by religions and in part by the major universalist ideologies, ethics has become more applied or practical

This new techno-scientific configuration raises challenges for medical practice based on the Hippocratic tradition. thus uses the term 'metamorphosis of medical ethics', a historical process consisting of four periods or stages, according to the author:

1st stage ­ begun by Hippocrates and his disciples and marked by a long period of tranquillity in which the Hippocratic tradition (enriched over the centuries by Stoicism and monotheistic religious traditions) was seen as a given, a belief prevailing until the 1960s;

2nd stage ­ characterized as a stage of philosophical investigation during which moral theories based on principles began to transform medical ethics (began in the 1960s and prevailed until the mid-1980s);

Emphasis on health care model:

The healthcare sector in the modern era, despite witnessing numerous breakthroughs in the field of medicine and pharmacology together with an astonishing healthcare expenditure, reflects a grim scenario since affordable, accessible and quality healthcare to every segment of the population continues to remain a distant dream which is precipitated by the worldwide lack of highly skilled healthcare professionals. Furthermore, modernization of lifestyle and a rapidly ageing population have set the conditions ripe for a plethora of chronic diseases such as cardiovascular diseases, diabetes, and hypertension which require long-term continuous treatment and management leading to a substantial economic burden on the healthcare system as well as accounting for 70% of deaths globally [. To make matters worse, communicable diseases such as lower respiratory infections, diarrheal diseases, and tuberculosis continue to haunt global health by featuring amongst the top ten causes of death in 2015 and thus lead to a double burden of disease . In addition to this, patient safety has become a burning issue, with the World Health Organization (WHO) estimating that 1 in 10 patients are harmed while receiving hospital care in developed countries due to preventable medical errors . Moreover, antibiotic resistance has taken the medical world by storm owing to the overuse and misuse of antibiotics and it is projected that many deaths occur annually as a result of bacterial infections which are resistant to antibiotics and hence place a considerable load on the healthcare sector.

some of the uses are:

patient centered cate

technology use

Teleconsultation and remote patient monitoring

Web as the source of health information

Webinars

Wearable sensors

Insideable devices

Mobile apps

Electronic Medical Records (EMR)

Health portals

The human genome project

Personalized and precision medicine

3D Printing

Artificial intelligence in healthcare

Undoubtedly, the road to achieving quality, equitable, accessible and affordable healthcare for all sections of the populations is laid with numerous hurdles, even so, not all is lost. The paradigm shift in healthcare delivery towards patient-centered care has restructured the dynamics of the relationship between the patient and the provider and is allowing patients to play a vigorous role in safeguarding their own health. Furthermore, as the information and communication technology sector revels in several cutting-edge innovations with gadgets like smartphones and tablets becoming increasingly available to common man and providing an innovative means to uphold patient-centric values, it became imperative for the health sector to exploit the benefits of this resource leading to the digitalization of the health sector and driving the momentum towards improving health and wellbeing of the people. Notwithstanding the criticism surrounding the use of technology in healthcare, the benefits far outweigh the challenges and digitalized health continues to flourish. Although this area of health care is in its nascent stages given that embracing it has been snail-paced and has a long way to go in its implementation, building up its evidence base and developing a regulatory framework, an enthusiasm is brewing in view of its unprecedented potential in disease treatment, disease prevention and promotion of health. It has the ability to reach out to every person, at every stratum in need of healthcare and may thus prove to be a silver lining in the healthcare system.