Familiar classifications guide us in diagnosis. Statistical analyses direct our therapy. Are these guides adequate to the task of diagnosing a disease and treating a patient as a person? Are they up to the demands of holistic medicine? Answering in the negative, two recent articles1,2 offer suggestions for modifying our approaches to diagnosis and treatment.
In communication titled "Beyond Diagnosis," McWhinney1 proposes that we add to the clinical diagnosis of disease a behavioral and a social diagnosis derived from two complementary classification schemata. The behavioral schema specifies five reasons for which a patient sees his doctor: limit of pain, limit of anxiety, problems of living presenting as symptoms, administrative problems, and disease prevention. The social schema encompasses seven social factors in illness: loss, conflict, change, maladjustment, stress, isolation, and frustration. Thus, a patient involved in an extramarital affair who saw his doctor about a genital mole because he
Beyond Diagnosis and Statistics. JAMA. 1973;223(4):435. doi:10.1001/jama.1973.03220040049015