Abstract

My experiences as a cancer patient have helped me understand the complexity of illness in ways which I could not fully appreciate as a physician trying to be attentive to my patients. My experiences with managed care helped me appreciate that our system of healthcare finance fundamentally misconstrues the nature of illness and what the healthcare system should be trying to accomplish. As a cancer patient, I was thankful for sophisticated technology such as bone marrow transplant, but it is a grim technology. Without the attentive care of the Duke staff and the love and support of friends and family, it would have been unbearable. I consider this the spiritual side of care, not necessarily in a supernatural sense, but certainly in a transcendent sense. In calling for a new "new medical model," I am suggesting a model that encompasses such spirituality, such transcendence. George Engel identified the need for a "new medical model" more than 30 years ago.¹ The model he proposed was the bio-psycho-social model intended to expand the bio-reductionistic model then in force. The bio-reductionistic model held that everything one needs to know about medicine could be explained by reducing illness to its biological components. That model was extremely successful up to a point. There had been many advances in biomedicine that supported the treat-the-body-as-a-machine approach. Even organs could be replaced like the worn out parts of an old automobile.