Los modelos biomedico y biopsicosocial en medicina / Biomedical and biopsychosocial models in medicine

Se introduce el concepto de modelos en la ciencia y práctica médicas. Se analizan dos modelos vigentes en la medicina contemporánea: el modelo "biomédico" (MBM), actualmente predominante, y el modelo bio-psico-social (MBPS), que cuestiona el reduccionismo del primero. Se revisa la historia y contenido conceptual de ambos. Se revisa la "teoría general de sistemas" como referente de ambos modelos. Se introduce el ''modelo centrado en el paciente" como práctica dialógica.

The concept of models in medical science and practice is introduced. Two current models in contemporary medicine are analyzed: the "biomedical" model (MBM), currently predominant, and the bio-psycho-social model (MBPS), which questions the reductionism of the former. The history and conceptual content of both are reviewed. The "general systems theory" is reviewed as a reference for both models. The "patient-centered model" is introduced as a dialogic practice.

Os sentidos atribuídos à deficiência pelos profissionais de saúde e o acesso das pessoas com deficiência aos serviços de saúde / The meanings attributed to disability by health professionals and the access of people with disabilities to health services

Objetivo: O estudo analisa como os profissionais da rede pública de saúde de doze municípios do Estado de São Paulo, Brasil - atribuem sentidos à "deficiência". Método: Foram realizadas 121 entrevistas semi-estruturadas, em 63 serviços. Os profissionais responderam a pergunta: Para você o que é deficiência/incapacidade? Os depoimentos foram organizados em núcleos temáticos e interpretados sob a perspectiva sócio histórica. Resultados: Constatou-se que predomina uma compreensão preconceituosa, assistencialista e paternalista sobre a deficiência. Observou-se nos depoimentos uma hesitação entre os sentidos atribuídos à deficiência e incapacidade, com abordagens reducionistas pautadas em paradigmas organicistas e/ou calcadas no senso comum. Não houve depoimentos que explicitassem conceitos de deficiência na perspectiva do modelo social de deficiência. Conclusão: É essencial que os serviços de saúde promovam espaços de reflexão entre profissionais sobre seus valores e sentidos que atribuem à deficiência e à prática assistencial, o que pode contribuir para a transformação cultural dos sentidos atribuídos ao fenômeno da deficiência e para o acesso aos bens de saúde

Objective: The study analyzes how professionals from the public health network in twelve municipalities in the State of São Paulo, Brazil - attribute meanings to "disability". Method: 121 semi-structured interviews were carried out in 63 services. The professionals answered the question: For you, what is disability? The testimonies were organized into thematic nuclei and interpreted from a sociohistorical perspective. Results: It was found that a prejudiced, charity and paternalistic understanding of disability prevails. A hesitation between the meanings attributed to disability and incapacity was observed in the testimonies, with reductionist approaches based on organicist paradigms and/or grounded in common sense. There were no statements that explained the concepts of disability from the perspective of the social model of disability. Conclusion: It is essential that health services promote spaces for reflection among professionals about their values and meanings they attribute to disability and care practice, which can contribute to the cultural transformation of the meanings attributed to the phenomenon of disability and to access to goods of health

História das abordagens científicas, médicas e psicológicas sobre as transexualidades e suas aproximações críticas / A history of scientific, medical and psychological approaches to transsexualities and their critical approach

Resumo Neste artigo, apresenta-se um breve enquadramento histórico das abordagens científicas, médicas e psicológicas sobre as transexualidades, tecendo um conjunto de considerações sobre a forma como tal enquadramento foi fundacional da noção de patologia associada às pessoas trans e como tem sido responsável pela manutenção da patologização destes indivíduos no imaginário coletivo. Para atingir tal objetivo, é desenhado um mapa cronológico dos acontecimentos que têm vindo a marcar, ao longo da história, o estudo e a intervenção com as pessoas trans a partir do modelo biomédico, referenciando algumas das personalidades que, no contexto ocidental, tiveram responsabilidade nesta visão biomédica das pessoas trans. No final deste trabalho, apresenta-se a discussão em torno da (des)patologização das transexualidades a partir do surgimento do paradigma centrado nos direitos humanos das pessoas trans e em propostas de autodeterminação dos seus corpos e identidades.

Abstract This study provides a brief historical background of scientific, medical and psychological approaches to transsexualities. It also makes considerations on how such approaches based the concept of pathology that is associated with trans people and how it has been responsible for maintaining the pathologization in the collective imaginary. More specifically, we will establish a chronology of events that, throughout history, have affected the study on and the intervention with trans people, based on the biomedical model. We will also refer to some Western figures responsible for creating this biomedical vision of trans people. Finally, the discussion about the (de)pathologization of transsexualities is presented, based on the emergence of the paradigm centered on the human rights of trans people and proposals for self-determination of their bodies and identities.

Praxis Bioanalítica desde la matriz epistemológica vigente en el contexto de la Salud Pública / Bioanalytic practice from the epistemological matrix in force in the context of Public Health

Con el propósito de caracterizar la praxis Bioanalítica desde la matriz epistemológica vigente, la investigación se realizó bajo el Enfoque Integrador Transcomplejo. Para el abordaje de la problemática de estudio se empleó la complementariedad metódica. El grupo humano quedó constituido por cinco docentes Bioanalistas, a los que se le realizó una entrevista focalizada y en profundidad. Entre los hallazgos se evidenció que la praxis bioanalítica fue modelada desde la modernidad como un ejercicio mecanicista, repetitivo, desarticulado de lo social y lo humano. La modernidad es reproducida en las universidades mediante una formación vertical, donde no se articula lo biológico con lo social, con lo histórico o lo cultural; ya que la malla curricular está definida por un grupo de asignaturas cargados de contenidos procedimentales, impartidos a partir de objetivos de forma aislada, que centra la atención en la enfermedad y concibe su praxis desde roles y tareas, dándole mayor énfasis al rol de analista. Desde esta perspectiva, se niega los aportes dados por la epistemología, la historia, lo sociología, antropología y la educación al saber Bioanalítico, quedando limitado su impacto en la Salud Pública. Para redimensionar la concepción social del Bioanálisis y su praxis es necesario que se asuman nuevos paradigmas y nuevas metodologías y la Transcomplejidad constituye una opción para dar respuesta a esta demanda.

In purpose to characterize the Bioanalytical praxis from the current epistemological matrix, the research was carried out under the TranscomplexIntegrative Approach. Methodical complementarity was used to address the study problem. The human group was made up of five Bioanalyst teachers, who were given a focused and in-depth interview. Among the findings, it was evident that bioanalytic praxis was modeled since modernity as a mechanistic, repetitive, disjointed exercise of the social and the human. Modernity is reproduced in universities through vertical training, where the biological is not articulated with the social, with the historical or the cultural; since the curricular mesh is defined by a group of subjects loaded with procedural content, taught from objectives in isolation, which focuses attention on the disease and conceives its praxis from roles and tasks, giving greater emphasis to the role of analyst. From this perspective, the contributions given by epistemology, history, sociology, anthropology and education to Bioanalytical knowledge are denied, leaving their impact on Public Health limited. To resize the social conception of Bioanalysis and its praxis, it is necessary to assume new paradigms and new methodologies and Transcomplexity constitutes an option to respond to this demand.

Potencialidades e desafios das práticas corporais e atividades físicas no cuidado e promoção da saúde / Potentialities and challenges of body practice and physical activities in care and health promotion / Potencialidades y desafíos de las prácticas corporales y actividades físicas en la atención y promoción de la salud

Em vista do reconhecimento do desafio da aproximação entre o Cuidado e a Promoção da Saúde, este ensaio teve como objetivo apontar elementos para que as Práticas Corporais e Atividades Físicas se tornem uma importante "ponte" entre eles. Como potências foram destacados: seu potencial impacto no desenvolvimento humano e sua contribuição para uma vida mais satisfatória e prazerosa; as possibilidades de envolvimento de distintas profissões contribuindo para o trabalho interprofissional; e de serem ricas na construção do cuidado compartilhado com as responsabilidades partilhadas entre os sujeitos e os profissionais de saúde. Como dificuldades e desafios: a formação profissional focada na lógica biomédica e na prática individualizada; a dificuldade na integração das ações e as condições de trabalho inadequadas. Conclui-se que as as Práticas Corporais e Atividades Físicas, como um fenômeno complexo e multideterminado, possuem grande potencial para a almejada aproximação entre a Promoção da Saúde e o Cuidado.

In view of the recognition of the challenge of the approximation between Care and Health Promotion, this essay aimed to point out elements for Body Practices and Physical Activities to become an important "bridge" between them. As powers were highlighted: its potential impact on human development and its contribution to a more satisfying and pleasant life; the possibilities of involving different professions contributing to interprofessional work; and to be rich in the construction of shared care with responsibilities shared between subjects and health professionals. As difficulties and challenges: professional training focused on biomedical logic and individualized practice; the difficulty in integrating actions and inadequate working conditions. It is concluded that the Body Practices and Physical Activities, as a complex and multidetermined phenomenon, have great potential for the desired approximation between Health Promotion and Care.

En vista del reconocimiento del desafío de la aproximación entre Cuidado y Promoción de la Salud, este ensayo tuvo como objetivo señalar elementos para que las Prácticas corporales y las Actividades físicas se conviertan en un importante "puente" entre ellas. Como se destacaron los poderes: su impacto potencial en el desarrollo humano y su contribución a una vida más satisfactoria y placentera; las posibilidades de involucrar a diferentes profesiones que contribuyen al trabajo interprofesional; y ser rico en la construcción de cuidados compartidos con responsabilidades compartidas entre sujetos y profesionales de la salud. Como dificultades y desafíos: formación profesional centrada en la lógica biomédica y la práctica individualizada; la dificultad para integrar acciones y condiciones de trabajo inadecuadas. Se concluye que las prácticas corporales y las actividades físicas, como un fenómeno complejo y multideterminado, tienen un gran potencial para la aproximación deseada entre la promoción de la salud y la atención

Experiências de estagiários em plantão psicológico em hospitais: formação e ação clínica / Experiences of trainees in prompt psychological attention in hospitals: education and clinical action / Experiencias de pasantes en servicio de emergencia psicológica en hospitales: formación y acción clínica

O artigo investigou como o plantão psicológico em hospital atua na formação de alunos em psicologia, no contexto de tensões entre o modelo biomédico e concepções mais pluralistas de saúde. Foram utilizados como fontes de dados 48 diários de bordo elaborados pelos estagiários de psicologia, relatando suas impressões, vivências e seu processo de compreensão do fazer profissional, construindo um relato de experiência. O material foi analisado na perspectiva da hermenêutica fenomenológica, buscando discutir significações desveladas e correlacionadas, bem como sentidos tomados pelo fazer psicológico. O plantão psicológico na instituição hospitalar promoveu o questionamento dos modos usuais de intervenção psicológica e ponderou um enfoque mais integral do cuidado em contraposição à visão unicista, possibilitando aprendizagem, reflexão e desenvolvimento de propostas interventivas.

The article investigated how psychological emergence attendance in a hospital works in the training of students in psychology, in the context of tensions between the biomedical model and pluralistic conceptions of health. As data sources, 48 field diaries were elaborated by psychology trainees, reporting their impressions, experiences and their process of understanding the professional duty, developing a experience report. The analysis was conduct by phenomenological hermeneutics point of view, looking for discuss unveiled and correlated meanings, as well as senses taken by psychological doing. The psychological emergence attendance at the hospital promoted the examination of the usual modes of psychological intervention and considered a more integral approach to care as opposed to the single view, allowing new learning, reflections and proposals of interventions.

Este trabajo investiga la formación de pasantes de Psicología en servicio de emergencia psicológica - práctica que tiene como objetivo buscar sentido en el momento en que suceden situaciones de emergencia - en hospitales, instituciones tradicionalmente biomédicas. Se utilizaron como fuentes de datos 48 diarios de a bordo elaborados por los pasantes de psicología, relatando sus impresiones, vivencias y su proceso de comprensión del hacer profesional, construyendo un relato de experiencia. El material fue analizado en la perspectiva de la hermenéutica fenomenológica, buscando discutir significaciones desveladas y correlacionadas, así como sentidos tomados por el hacer psicológico. El plantón psicológico en la institución hospitalaria promovió el cuestionamiento de los modos usuales de intervención psicológica y ponderó un enfoque más integral del cuidado en contraposición a la visió unica, posibilitando el aprendizaje, la reflexión y el desarrollo de propuestas interventivas.

Sobre as práticas tradicionais de cura: subjetividade e objetivação nas propostas terapêuticas contemporâneas / Sur les pratiques traditionnelles de cure: subjectivité et objectivation dans les propositions thérapeutiques contemporaines / Sobre las prácticas tradicionales de cura: subjetividad y objetivación en las propuestas terapéuticas contemporáneas / On traditional healing practices: subjectivity and objectivation in contemporary therapeutics

O presente trabalho constitui uma pesquisa de cunho teórico, na qual é traçado um breve percurso histórico das práticas de cura tradicionais e se faz também uma discussão sobre sua permanência e eficácia na contemporaneidade, apesar dos avanços na área da ciência médica. Tendo em vista a importância crescente da subjetividade na medicina contemporânea, nossa hipótese visa salientar que a objetivação do sujeito doente, operada pelas práticas médicas, condena a subjetividade a um segundo plano e representa uma lacuna importante nas propostas terapêuticas do modelo biomédico. Nosso objetivo é interrogar o lugar das práticas tradicionais de cura nessa lacuna deixada pela medicina e no que tais práticas podem contribuir para o modelo médico.

Ce travail est une recherche théorique où l'on esquisse un bref parcours historique sur les pratiques traditionnelles de cure et on fait aussi un débat sur leur permanence et efficacité dans le monde contemporain, malgré les avancées dans le domaine de la médecine scientifique. En rendant compte l'importance croissante de la subjectivité dans la médecine contemporaine, notre hypothèse souligne que l'objectivation du sujet malade opérée par les pratiques médicales condamne à l'oubli la subjectivité et produit une lacune importante dans les démarches thérapeutiques du modèle biomédical. Notre objectif en est celui d'interroger la place des pratiques traditionnelles de cure dans cette lacune laissée par la médecine et comment ces pratiques peuvent-elles contribuer avec le modèle médical actuel.

Este trabajo esboza un camino histórico por las prácticas tradicionales de cura y, junto a esto, una discusión sobre la permanencia y la eficacia de estas prácticas en el mundo contemporáneo, a pesar de los progresos de la medicina científica. Considerando la importancia creciente de la subjetividad en la medicina contemporánea, nuestra hipótesis destaca que la objetivación del sujeto enfermo operada por las practicas medicales impone un olvido de la subjetividad y produce un vacío importante en las terapéuticas del modelo biomédico. Nuestra meta es investigar el lugar de las prácticas tradicionales de cura en este vacío de sentido de la medicina y se ellas pueden enseñar algo al modelo médico actual.

Abstract This article is a theoretical study featuring a brief historical outline of traditional healing practices and also a discussion on their persistence and efficiency in the contemporary world, despite the advances of scientific medicine. Given the increasing relevance of subjectivity in contemporary medicine, our hypothesis aims to emphasize that the objectivation of patients by medical practices eclipses the role of subjectivity and reveals an important deficit in the therapeutics of the biomedical model. Our aim is to understand the role of traditional healing practices and how they may contribute to the medical model.

Educación en ciencias de la salud, aproximación desde una nueva mirada de la Salud Pública / Education in health sciences, an approach from a new look of public health

This paper presents a literature review of links between Education of Health Sciences and the new looks from the public health in context of paradigmatic rupture processes. It is a result of the literature review carried out from the process of the skillsbased curriculum transformation at the University of Carabobo, in its Faculty of Health Sciences and Public Health Department - Aragua campus. It assumes a chronological sequence and context analysis of power relations hegemony - against hegemony. The argumentative debate context of the biomedical model - hegemonic Cartesian, with its dialectical complementarity: Clinic - Preventivist Model and the emergence of alternative looks from the public health and social medicine - collective health, among others. The reader is confronted against paradigmatic rupture processes, the human civilization crisis, their alternative and social rises that are presented.

El presente artículo expone una revisión documental de los nexos de la Educación en las Ciencias de la Salud y de las nuevas miradas desde la Salud Publica en contexto de procesos de ruptura paradigmática. Es producto de parte de la revisión de la literatura efectuada, desde el proceso de transformación curricular por competencias en la Universidad de Carabobo, en su Facultad de Ciencias de la Salud y su Departamento de Salud Pública de la Sede Aragua. Asume una secuencia cronológica y análisis de contexto de las relaciones de poder hegemonía - contra hegemonía. El debate argumentativo de contexto del modelo biomédico - cartesiano hegemónico, con su complementariedad dialéctica: Clínica - Modelo Preventivista y la emergencia de miradas alternas desde la Salud Publica como la Medicina Social - la Salud Colectiva, entre otras. Confronta al lector desde los procesos de ruptura paradigmática ante la crisis civilizatoria humana, las emergencias sociales y alternas que se hacen presentes.

Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis

Patient self-report questionnaires such as a multidimensional health assessment questionnaire (MDHAQ) have advanced knowledge concerning prognosis, care, course and outcomes of rheumatoid arthritis (RA). The MDHAQ may overcome some limitations of a "biomedical model," the dominant paradigm of contemporary medical services, including limitations of laboratory tests, radiographs, joint counts, and clinical trials, to predict and depict the long-term course and outcomes of RA. A complementary "biopsychosocial model" captures components of a patient medical history on patient questionnaires as quantitative, standard, "scientific" scores for physical function, pain, fatigue, and other problems, rather than as 'subjective" narrative descriptions. A rationale for a biopsychosocial model in RA includes the importance of a patient history in diagnosis and management compared to biomarkers in many chronic diseases such as hypertension and diabetes. Some important observations which support a biopsychosocial model in RA based on patient questionnaires include that MDHAQ physical function scores are far more significant than radiographs or laboratory tests to predict severe RA outcomes such as work disability and premature death; patient self-report measures are more efficient than tender joint counts and laboratory tests to distinguish active from control treatments in RA clinical trials involving biological agents; and MDHAQ scores are more likely than laboratory tests to be abnormal at presentation and to document incomplete responses to methotrexate at initiation of biological agents. Patient questionnaires can save time for doctors and patients, and improve doctor-patient communication. A standardized database of MDHAQ scores consecutive patients over long periods might be considered by all rheumatologists in routine clinical care.

Cultura y modelo biomédico: reflexiones en el proceso de salud enfermedad / Culture and biomedical model: reflections in the health-disease process

El presente ensayo tiene como propósito abordar el tema de la cultura y el modelo biomédico en el proceso de salud enfermedad a través de una serie de reflexiones. El hombre ha logrado construir diferentes conceptos sobre salud, enfermedad, formas de aliviarla, acciones para su prevención y fomento de la salud, de acuerdo con la cultura de cada sociedad y su forma de organización. El Modelo Biomédico tiene sus bases en el pensamiento racionalista cartesiano y de la física newtoniana, divide la naturaleza humana en cuerpo y mente y, el cuerpo es considerado como una estructura biológica cuyos elementos funcionan de acuerdo a leyes de la física clásica, en términos de movimientos y ajustes de sus partes. Es fundamental que en el proceso de salud enfermedad los sistemas médicos no sean vistos de manera aislada e imponente sino apreciados dentro de todo el ámbito de la cultura y la sociedad en la que funcionan. Se debe lograr un engranaje entre la cultura y el modelo biomédico en el proceso de salud-enfermedad, ya que ambos pueden lograr la complementariedad y así mejorar el bienestar social y colectivo.

This paper aims to address the issue of culture and the biomedical model in the health-disease process through a series of reflections. The man has built different concepts of health, disease, ways to relieve it, measures for prevention and health promotion, according to the culture of each society and its form of organization. Model Biomedical is rooted in the Cartesian rationalist thought and Newtonian physics, divided human nature, body and mind and the body is considered as a biological structure whose elements operate according to laws of classical physics, in terms of movement and settings of its parts. It is essential that in the process of health illness medical systems are not seen in isolation and imposing but appreciated in the entire field of culture and society in which they operate. It must achieve a gear between culture and the biomedical model in the health-disease process, as both can achieve complementarity and improve the social and collective welfare.

Encontros ou Desencontros: histórias de idosos que tentaram suicídio e a Rede de Atenção Integral em Porto Alegre/RS, Brasil / Convergence and Non-Convergence: stories of elderly who have attempted suicide and the Integrated Care System in Porto Alegre/RS, Brazil

Este artigo, fruto do trabalho de pesquisa realizado na cidade de Porto Alegre/RS, visa colocar em discussão um fenômeno, pouco conhecido, que é a tentativa de suicídio em idosos. A subnotificação das tentativas nessa população tem dificultado a inserção desse grave problema de saúde pública na agenda política. Neste estudo, foram entrevistados não só idosos que atentaram contra a própria vida como os seus familiares e profissionais vinculados a serviços de emergência e de urgência em geral e em saúde mental, no ano de 2014. A análise textual discursiva permitiu identificar, nos diferentes relatos, a emergência da categoria intitulada encontros e desencontros, que aborda a relação entre as necessidades de cuidado dos idosos e o modelo de atenção em saúde. O estudo, por meio de três breves histórias, questiona o modelo biomédico quanto ao atendimento a situações de risco e enfatiza, para a conquista da atenção integral em saúde, a concepção da Clínica Ampliada. Essa concepção privilegia, nas diferentes formas de cuidado, a singularidade do usuário que tem sido, muitas vezes, negligenciada no modelo biomédico. O estudo também destaca a necessidade da construção de uma linha de cuidado para a população idosa, bem como investimentos em educação permanente sobre o tema do envelhecimento ativo e do acolhimento na crise, sob a perspectiva da articulação da rede intersetorial.

This article is the product of research undertaken in the city of Porto Alegre, in the Brazilian state of Rio Grande do Sul. The goal is to bring to light and discuss a little known phenomenon - attempted suicide by the elderly. Under-reporting of suicide attempts among this population makes it difficult to place this serious public health problem on the political agenda. As part of this study, we interviewed not only elderly persons who had attempted suicide, but also their family members and mental health and emergency and urgent service professionals. These interviews took place during the course of 2014. From a textual discourse analysis of the various reports, there emerged a category we will call Convergence and Non-Convergence, which deals with the relationship between the elderly population's need for care and the healthcare model in use. This study uses three short stories of individuals to question the biomedical model of serving risk situations, stressing the concept of an Expanded Clinic to provide integrated healthcare. This concept focuses on the different types of care and the uniqueness of each user, which often the biomedical model neglects. This study also highlights the need to develop a line of care for the elderly, with investments in continued education about active aging and care in times of crises, articulating a cross-sectorial network.

El Análisis Existencial en la escuela: de la restricción al encuentro creativo / Existential Analysis in school: the restriction to creative meeting

Este artículo expone una revisión y una serie de reflexiones en torno al Análisis Existencial sobre el diagnóstico y la intervención psicológica en contextos escolares. Se revisaron y contrastaron las contribuciones de distintos autores representativos del modelo biomédico y del modelo bio-psico-socio-espiritual en torno a la intencionalidad del psicodiagnóstico escolar. Se discute sobre la aplicabilidad de estas propuestas (modelo biomédico y modelo bio-psico-socio-espiritual) al Análisis Existencial en los programas de ayuda a niños, niñas y adolescentes que pasan por diferentes dificultades para afrontar situaciones propias de la existencia humana que se presentan en contextos escolares.

This article summarizes some theoretical reflections about the personal and Existential Analysis on diagnosis and psychological interventions in school settings. Were reviewed and contrasted the contributions of various authors representative of the biomedical model and the bio-psycho-socio-spiritual about the intentionalities of the school psychodiagnostic. We discuss the applicability of these proposals (bio-medical model and bio-psycho-socio-spiritual) to Existential Analysis in programs to help children and young people whom throw out to different difficulties, specificly to human existence that presented in school settings.

Psychosocial trauma of diagnosis: A qualitative study on rural TB patients' experiences in Nalgonda district, Andhra Pradesh.

Background: The current tuberculosis (TB) control strategy in India largely ignores psychosocial needs of the patients. The present study was prompted by the recognition that, if TB treatment is to be culturally sensitive and effective, the psychosocial problems and issues need to be recognized and addressed. Aims: The main aim of this study was to explore psychosocial problems and issues among rural patients being diagnosed with TB. Methods: 110 respondents who had known about their TB diagnosis less than two months prior to conducting the interviews were recruited purposively from two selected rural TB units at Yadagirigutta and Chintapally in Nalgonda district in Andhra Pradesh (A.P.). Semi-structured interview schedule was used for the collection of primary data. A qualitative content analysis method was employed to analyze and interpret the data. Data analysis was carried out following multi-step procedure that consisted of data reduction, coding and identification of dominant themes. Results: The diagnosis of TB was generally seen as a shocking and demoralizing experience, and raised a host of social and psychological problems among the patients. Six prominent themes emerged from the in-depth interviews with the respondents: i) worry, ii) disbelief, iii) embarrassment, iv) fear of death, v) fate, and vi) relief. Conclusion: Effective care for TB requires a much broader approach beyond focusing on anti-tuberculosis drugs and diagnostic techniques. For medical care to be most effective and acceptable to patients, general practitioners should treat both illness and disease in their patients at the same time. Knowledge of the nature of psychosocial problems is crucial for the design of new approaches and methods to improve the quality of life of TB patients.

Christian Ideals in the History of Medical Care / 의사학

Probably because the Renaissance period tended to be overglorified, people have even come to equate the "Middle Ages" with the "Dark Ages". But some writings have recently expressed positive views on the "Middle Ages" in history. The Christian teachings from the Middle Ages concerning the sick and the poor have undoubtedly contributed to forming the ideals of modern medical care. Today's medical facilities run especially by churches are expected to continue their services based on a biopsychosociomedical model rather than on a biomedical mode.