Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Reductionism and daily medical practice

George Lundberg, MD
Physician
March 28, 2011
Share
Tweet
Share

The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.

The basic premise of reductionism is that by breaking down (or “reducing”) complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.

Historically, the invention of the microscope, the defining of Koch’s four infectious disease postulates, the unraveling of the human genome, and even intelligent computers are salient examples of the dramatic benefits of biomedical reductionism.

Conversely, Sir William Osler (modernizing Hippocrates) always believed that the art of medicine would never be completely replaced by reductionist science.

In 1977 in the journal Science, Dr. George Engel, a highly regarded Rochester psychiatrist, codified a bio-psycho-social (BPS) model for healthcare in the United States.

More recently Dr. Steven Schroeder from UCSF reminded us that biomedical intervention alone has much less impact on health outcomes than is commonly believed.

Classical medical care interventions contribute only about 10% to reducing premature deaths compared to other elements such as genetic predisposition, social factors, and individual health behaviors.

Most contemporary medical researchers have concluded that the chronic degenerative diseases of modern Western humans have multiple contributory causes, thus not lending themselves to the single agent-single outcome model.

Physician Rick Lippin has suggested that the mantle of Dr. Engel’s bio-psycho-social model of healthcare be reaffirmed and added a S for spiritual, recognizing that our patients have needs in all four of these domains.

As one method of incorporating this concept into daily medical practice, Lippin has recently proposed to the Joint Commission that all primary healthcare providers ask two simple questions when taking the medical history.

Modeled after the so-called fifth vital sign of pain, and utilizing the BPSS model, each adult patient should be asked:

  • How are things at work?
  • How are things at home?

The answers should be scaled between 1, couldn’t be better, and 10, couldn’t be worse (in crisis stage).

The answers of patients to these questions would lead to more questions and possible referrals and standardized tests for further diagnostic workup for stress and depression.

ADVERTISEMENT

Try adding these questions to your clinical routine to better understand your patients’ needs.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more primary care news.

Prev

Life at a needle exchange

March 27, 2011 Kevin 3
…
Next

ACP: Benefits, harms, and quality in high value, cost conscious care

March 28, 2011 Kevin 1
…

Tagged as: Primary Care

Post navigation

< Previous Post
Life at a needle exchange
Next Post >
ACP: Benefits, harms, and quality in high value, cost conscious care

ADVERTISEMENT

More by George Lundberg, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Pathologists face a stark career choice

    George Lundberg, MD
  • a desk with keyboard and ipad with the kevinmd logo

    A culture of cover-up has slowed the patient safety movement

    George Lundberg, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Do drugs aid and abet genius or does genius lead to drugs?

    George Lundberg, MD

More in Physician

  • Why judgment is hurting doctors—and how mindfulness can heal

    Jessie Mahoney, MD
  • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

    Olumuyiwa Bamgbade, MD
  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Reductionism and daily medical practice
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...