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
440 Shares
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.

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

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

  • Physicians are burned out. Could entrepreneurship be a cure?

    Arun Mohan, MD, MBA
  • The dark role of science, medicine, and tasers

    L. Joseph Parker, MD
  • Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans

    Dae Sun Hwang, Thomas Pak, MD, and Joo-Young Lee, MD
  • Escape diagnostic rabbit holes with Markov chains

    Anonymous
  • How medicine’s demanding training took my sleep away

    Jennifer Lycette, MD
  • Navigating physician shortages in rural communities

    Stacy Wentworth, MD
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • World AIDS Day 2023: Remember and commit

      Toyin M. Falusi, MD | Conditions
    • Breaking free from metric shaming [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating challenges in modern medicine through storytelling [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tackling health care conflicts and stereotyping

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • Medical ethics dilemma: a hemodialysis decision

      Jennifer Lycette, MD | Conditions
    • What we have to gain from weight loss drugs

      Hoag Memorial Hospital Presbyterian | Conditions
  • Recent Posts

    • Breaking free from metric shaming [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians are burned out. Could entrepreneurship be a cure?

      Arun Mohan, MD, MBA | Physician
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • Embracing life’s purpose in the face of inevitable death

      Michael Brant-Zawadzki, MD | Conditions
    • Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans

      Dae Sun Hwang, Thomas Pak, MD, and Joo-Young Lee, MD | Physician
    • AI’s role in streamlining colorectal cancer screening [PODCAST]

      The Podcast by KevinMD | Patient, Podcast

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

CME Spotlights

From MedPage Today

Latest News

  • This Many U.S. Adults Have Chronic Fatigue Syndrome
  • Biden's Risky Ladder Climb? Pharmacy Items vs Abortion Pills; ED Drink of Choice
  • MedPAC Draft Recommendation Calls for 1.3% Pay Bump for Medicare Clinicians
  • Adding Immunotherapy to Neoadjuvant Chemo Boosts pCR in HR-Positive Breast Cancer
  • White House Says It Can Seize Certain Drug Patents to Lower Prices

Meeting Coverage

  • Adding Immunotherapy to Neoadjuvant Chemo Boosts pCR in HR-Positive Breast Cancer
  • ED Visits for Migraine More Likely in Rural Areas
  • The Treatment Landscape for Cervical Cancer Has Changed
  • No Benefit to Adjuvant-Only Immunotherapy in Early TNBC
  • De-Escalating Breast Cancer Treatment Feasible After Response to Neoadjuvant Chemo
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • World AIDS Day 2023: Remember and commit

      Toyin M. Falusi, MD | Conditions
    • Breaking free from metric shaming [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating challenges in modern medicine through storytelling [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tackling health care conflicts and stereotyping

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • Medical ethics dilemma: a hemodialysis decision

      Jennifer Lycette, MD | Conditions
    • What we have to gain from weight loss drugs

      Hoag Memorial Hospital Presbyterian | Conditions
  • Recent Posts

    • Breaking free from metric shaming [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians are burned out. Could entrepreneurship be a cure?

      Arun Mohan, MD, MBA | Physician
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • Embracing life’s purpose in the face of inevitable death

      Michael Brant-Zawadzki, MD | Conditions
    • Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans

      Dae Sun Hwang, Thomas Pak, MD, and Joo-Young Lee, MD | Physician
    • AI’s role in streamlining colorectal cancer screening [PODCAST]

      The Podcast by KevinMD | Patient, Podcast

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...