Theoretical Foundations of
Family Medicine
MCI.Sc. 503
Course Instructors: Tom Freeman MD, Ian R. McWhinney MD
OBJECTIVES:
The principal objective of this course is to place medicine and, in particular, family medicine, in the context of 20th century ideas. Medicine has gone through a period of rapid technological advance resulting in great practical achievements. This may be the reason that it has tended to isolate itself from what is happening in the world around it, clinging onto ideas long after the rest of the world has rejected them-for example, our ideas about what science is. Medicine has tended to shy away from examining fundamentals. This period is now at an end and, while the technological advances will continue, the real ferment now occurring in medicine-partly as a result of these achievements-makes it necessary for us to examine fundamentals.
In this course we will be discussing concepts which we usually take for granted. Is medicine a science, an art, a craft, a technology or all of these? What is science and what knowledge does it give us? What are its limitations? What is technology and how has it altered our worldview? What is quality in medicine and how do we judge it? What do we mean by health and disease? What is a diagnosis? What do we mean by cause? Is there a difference between healing and curing? What is medical knowledge? How is it acquired and how should it be taught?
Family medicine is comparatively new as an academic discipline, though it has been practiced for many years at an intuitive level. For a new discipline, an examination of fundamentals is essential.. Our own view is that the emergence of family medicine as a discipline in the late 20th century is a response to the ferment taking place in medicine. Our role, then, is to face the profession with some of the issues which, because of our experience, we face every day of our lives. We believe also that we represent a different way of approaching and practicing medicine. Is medicine undergoing a paradigm shift and does family medicine represent a new paradigm? These are some of the questions which we will be discussing in the course.
COURSE SCHEDULE
| Seminar | Title |
Readings |
| 1. | Theory of Paradigm Change | Wuff, Pederson, Rosenberg Philosophy of Medicine Chpts. 1 and 4 |
| 2. | Theory of Paradigm Change | Chpts. 2 and 3 |
| 3. | The Origins of Science | Whitehead, AN Science and the Modern World, Chpts. 1 and 3 |
| 4. | The Theory of Knowledge | Schumacher, EF Guide for the Perplexed Chpts. 1 to 5 |
| 5. | The Theory of Knowledge | Chpts. 6 to 9 |
| 6. | The Modern Paradigm of Knowledge | Lewis CS The Abolition of Man |
| 7. | The Modern Paradigm of Knowledge | Taylor, Charles The Malaise of Modernity |
| 8. | Technology | Franklin, Ursula The Real World of Technology |
| 9. | Technology | Postman, Neil Technopoly: The Surrender Of Culture to Technology |
| 10. | Personal Knowing | Polanyi, Michael Knowing and Being, Chpt. 10 |
| 11. | Personal Knowing | Chpt. 9 |
| 12. | Concepts of Health and Disease | Dubos, Rene Man Adapting pp. 254-279, pp.344-368 Wuff, Pedersen, Rosenberg Chpt. 8 |
| 13. | Aetiology | Dubos, Rene Man Adapting, Chpt. 12 Cassel, Eric The Contribution of the Social Environment to Host Resistance |
| 14. | The Theory of Diagnosis | Crookshank; The Theory of Diagnosis; Lancet 1926; 2: 934-942, 995-999 |
| 15. | The Doctor and the Experience of Suffering | Neddleman, Jacob The Way of the Physician |
| 16. | The Experience of Illness | Frank, Arthur At the Will of the Body |
17. |
General System Theory | Von Bertalanffy General System Theory - Foundations, Development, Applications, Chpt. 2 and 9 Bateson, Gregory: Steps to An Ecology of Mind |
18. |
A New Paradigm | Foss, Laurence Teleological Coherence: Psychoneuroimmunology andThe Philosophy of Medicine, 1992. |