Dualism in medicine: A scenario

Abstract

The physician's role has a dualism inherent within it: a concern for society's health problems and generic solutions to them and a need to find specific remedies for the conditions of individual patients. This paper asserts that a recognition of this dualism and of the difficulties encountered nationally and internationally in distributing medical care on an equitable basis has created a favorable climate for evaluating the problems of providing and assessing the quality of health care. Suggestions for solving the problems are discussed and include those of Ivan Illich. The author's suggestions are given in contrast to Illich's non-medical suggested solutions. Among them are improvement in the teaching of population-based medicine in the undergraduate curriculum; training of physicians, which includes special focus on the disciplines involved in population-based medicine; alteration of clinical training; development and promotion of self-care programs; more emphasis on epidemiology and bio-statistics; and the establishment of institutes of law and ethics to deal with health-related problems.