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Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare?

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Over the past decades, scientific medicine has realized tremendous advances. Yet, it is felt that the quality, costs, and equity of medicine and public health have not improved correspondingly and, both inside and outside the USA, may even have changed for the worse. An initiative for improving this situation is value-based healthcare, in which value is defined as health outcomes relative to the cost of achieving them. Value-based healthcare was advocated in order to stimulate competition among healthcare providers and thereby reduce costs. The approach may be well grounded economically, but in the care of patients, “value” has ethical and philosophical connotations. The restriction of value to an economic meaning ignores the importance of health and, thus, leads to misunderstandings.

We postulate that a new understanding of the nature of health is necessary. We present the Meikirch model, a conceptual framework for health and disease that views health as a complex adaptive system. We describe this model and analyze some important consequences of its application to healthcare.

The resources each person needs to meet the demands of life are both biological and personal, and both function together. While scientific advances in healthcare are hailed, these advances focus mainly on the biologically given potential (BGP) and tend to neglect the personally acquired potential (PAP) of an individual person. Personal growth to improve the PAP strongly contributes to meeting the demands of life. Therefore, in individual and public health care, personal growth deserves as much attention as the BGP. The conceptual framework of the Meikirch model supports a unified understanding of healthcare and serves to develop common goals, thereby rendering interprofessional and intersectoral cooperation more successful. The Meikirch model can be used as an effective tool to stimulate health literacy and improve health-supporting behavior. If individuals and groups of people involved in healthcare interact based on the model, mutual understanding of and adherence to treatments and preventive measures will improve. In healthcare, the Meikirch model also makes it plain that neither pay-for-performance nor value-based payment is an adequate response to improve person-centered healthcare.

The Meikirch model is not only a unifying theoretical framework for health and disease but also a scaffold for the practice of medicine and public health. It is fully in line with the theory and practice of evidence-based medicine, person-centered healthcare, and integrative medicine. The model offers opportunities to self-motivate people to improve their health-supporting behavior, thereby making preventive approaches and overall healthcare more effective.

We believe that the Meikirch model could induce a paradigm shift in healthcare. The healthcare community is hereby invited to acquaint themselves with this model and to consider its potential ramifications.

No MeSH data available.


Related in: MedlinePlus

Traditional and person-centered careComparison of traditional medicine and person-centered care. The ordinate on the left-hand side expresses Newtonian science as it is customary in traditional medicine. The right-hand side represents thinking used in complex adaptive systems (CAS). Each diagnosis and treatment must always consider both factors: For hip replacement, methods of conventional medicine are predominant, and for psychotherapy, methods are based on CAS. Yet, in each case, the other factor also applies to some degree. Interestingly, the example of Type 1 diabetes mellitus is approximately in the middle. The patient must understand the physiology of glucose and insulin metabolism and must be able to measure blood glucose and inject insulin. Ultimately, however, he or she must feel that meticulous self-treatment serves her or his purpose best because it leads to the best possible future. This insight results from processes related to a CAS.
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FIG4: Traditional and person-centered careComparison of traditional medicine and person-centered care. The ordinate on the left-hand side expresses Newtonian science as it is customary in traditional medicine. The right-hand side represents thinking used in complex adaptive systems (CAS). Each diagnosis and treatment must always consider both factors: For hip replacement, methods of conventional medicine are predominant, and for psychotherapy, methods are based on CAS. Yet, in each case, the other factor also applies to some degree. Interestingly, the example of Type 1 diabetes mellitus is approximately in the middle. The patient must understand the physiology of glucose and insulin metabolism and must be able to measure blood glucose and inject insulin. Ultimately, however, he or she must feel that meticulous self-treatment serves her or his purpose best because it leads to the best possible future. This insight results from processes related to a CAS.

Mentions: Many acute and chronic conditions of the physical body are appropriately treated by surgery or by drugs, as supported by empiric evidence and by the current practice of medicine. Such interventions in the BGP may be essential when a treatment is a lifesaving or when it may prolong a meaningful state of health. Today, the efficacy of this approach is demonstrated by the well-recognized successes of clinical research and healthcare, including evidence-based medicine. Yet, in every case, surgery or drug treatment is applied not simply to a biological organism, but specifically to an entire human being that responds with both of his or her potentials. This is illustrated in Figure 4. Insertion of a hip prosthesis concerns primarily the BGP and is therefore categorized as Newtonian science. On the other hand, psychotherapy deals mainly with the PAP and therefore reflects complexity science. However, both are not mutually exclusive. Recovery from a hip operation and rehabilitation strongly involve the PAP. Analogously, the physical symptoms of patients undergoing psychotherapy require adequate attention to the individual’s BGP. Interestingly, self-care of patients with Type 1 diabetes mellitus can be regarded as based on both the BGP and PAP, almost in equal parts. Measurement of blood glucose, adherence to an adequate diet, physical activity, and the injection of insulin concern the BGP and reflect Newtonian science. Knowledge of the glucose and insulin physiology and disciplined adherence to treatment, on the other hand, require a correspondingly developed PAP that reflects complexity science. In addition, appropriate care must make sense. This requires that patients and healthcare providers must equally respect the causality of Newtonian science and the rules of systems theory necessary to deal with a CAS.


Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare?
Traditional and person-centered careComparison of traditional medicine and person-centered care. The ordinate on the left-hand side expresses Newtonian science as it is customary in traditional medicine. The right-hand side represents thinking used in complex adaptive systems (CAS). Each diagnosis and treatment must always consider both factors: For hip replacement, methods of conventional medicine are predominant, and for psychotherapy, methods are based on CAS. Yet, in each case, the other factor also applies to some degree. Interestingly, the example of Type 1 diabetes mellitus is approximately in the middle. The patient must understand the physiology of glucose and insulin metabolism and must be able to measure blood glucose and inject insulin. Ultimately, however, he or she must feel that meticulous self-treatment serves her or his purpose best because it leads to the best possible future. This insight results from processes related to a CAS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383372&req=5

FIG4: Traditional and person-centered careComparison of traditional medicine and person-centered care. The ordinate on the left-hand side expresses Newtonian science as it is customary in traditional medicine. The right-hand side represents thinking used in complex adaptive systems (CAS). Each diagnosis and treatment must always consider both factors: For hip replacement, methods of conventional medicine are predominant, and for psychotherapy, methods are based on CAS. Yet, in each case, the other factor also applies to some degree. Interestingly, the example of Type 1 diabetes mellitus is approximately in the middle. The patient must understand the physiology of glucose and insulin metabolism and must be able to measure blood glucose and inject insulin. Ultimately, however, he or she must feel that meticulous self-treatment serves her or his purpose best because it leads to the best possible future. This insight results from processes related to a CAS.
Mentions: Many acute and chronic conditions of the physical body are appropriately treated by surgery or by drugs, as supported by empiric evidence and by the current practice of medicine. Such interventions in the BGP may be essential when a treatment is a lifesaving or when it may prolong a meaningful state of health. Today, the efficacy of this approach is demonstrated by the well-recognized successes of clinical research and healthcare, including evidence-based medicine. Yet, in every case, surgery or drug treatment is applied not simply to a biological organism, but specifically to an entire human being that responds with both of his or her potentials. This is illustrated in Figure 4. Insertion of a hip prosthesis concerns primarily the BGP and is therefore categorized as Newtonian science. On the other hand, psychotherapy deals mainly with the PAP and therefore reflects complexity science. However, both are not mutually exclusive. Recovery from a hip operation and rehabilitation strongly involve the PAP. Analogously, the physical symptoms of patients undergoing psychotherapy require adequate attention to the individual’s BGP. Interestingly, self-care of patients with Type 1 diabetes mellitus can be regarded as based on both the BGP and PAP, almost in equal parts. Measurement of blood glucose, adherence to an adequate diet, physical activity, and the injection of insulin concern the BGP and reflect Newtonian science. Knowledge of the glucose and insulin physiology and disciplined adherence to treatment, on the other hand, require a correspondingly developed PAP that reflects complexity science. In addition, appropriate care must make sense. This requires that patients and healthcare providers must equally respect the causality of Newtonian science and the rules of systems theory necessary to deal with a CAS.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Over the past decades, scientific medicine has realized tremendous advances. Yet, it is felt that the quality, costs, and equity of medicine and public health have not improved correspondingly and, both inside and outside the USA, may even have changed for the worse. An initiative for improving this situation is value-based healthcare, in which value is defined as health outcomes relative to the cost of achieving them. Value-based healthcare was advocated in order to stimulate competition among healthcare providers and thereby reduce costs. The approach may be well grounded economically, but in the care of patients, “value” has ethical and philosophical connotations. The restriction of value to an economic meaning ignores the importance of health and, thus, leads to misunderstandings.

We postulate that a new understanding of the nature of health is necessary. We present the Meikirch model, a conceptual framework for health and disease that views health as a complex adaptive system. We describe this model and analyze some important consequences of its application to healthcare.

The resources each person needs to meet the demands of life are both biological and personal, and both function together. While scientific advances in healthcare are hailed, these advances focus mainly on the biologically given potential (BGP) and tend to neglect the personally acquired potential (PAP) of an individual person. Personal growth to improve the PAP strongly contributes to meeting the demands of life. Therefore, in individual and public health care, personal growth deserves as much attention as the BGP. The conceptual framework of the Meikirch model supports a unified understanding of healthcare and serves to develop common goals, thereby rendering interprofessional and intersectoral cooperation more successful. The Meikirch model can be used as an effective tool to stimulate health literacy and improve health-supporting behavior. If individuals and groups of people involved in healthcare interact based on the model, mutual understanding of and adherence to treatments and preventive measures will improve. In healthcare, the Meikirch model also makes it plain that neither pay-for-performance nor value-based payment is an adequate response to improve person-centered healthcare.

The Meikirch model is not only a unifying theoretical framework for health and disease but also a scaffold for the practice of medicine and public health. It is fully in line with the theory and practice of evidence-based medicine, person-centered healthcare, and integrative medicine. The model offers opportunities to self-motivate people to improve their health-supporting behavior, thereby making preventive approaches and overall healthcare more effective.

We believe that the Meikirch model could induce a paradigm shift in healthcare. The healthcare community is hereby invited to acquaint themselves with this model and to consider its potential ramifications.

No MeSH data available.


Related in: MedlinePlus