Upgrade to broadview

I just upgraded my internet connection to broadband and it got me thinking about the narrowness of thinking which predominates in health care.
We have health services which are created around "disease management" but it isn't disease we treat, it's people.
So, should we have health services which are about "people management"? No, I don't think so!
We should have health services which are about caring for people.
Eric Cassell and others have written about the difference between the concept of "disease" and the concept of "illness". (See Cassell's "The Nature of Suffering").
Disease is a narrow view. It's about tissues or cells or single systems. It's about pathology. It's about what can be measured with equipment.
Illness is a broad view. It's about a person's experience, or, as Cassell says, it's about "the patient's suffering". Suffering can't be measured. It can only be told. We try to understand another's suffering by listening to their stories.
To understand health, we also need to take a broad view. Hans Georg Gadamer, in his collection of essays entitled "The Enigma of Health", makes it clear that health as an experience is kind of present when we are not aware of it. He says that doctors know their job is done when they aren't needed any more.
We can take a narrow view. We can say that health is about the absence of disease and we can define and measure the disease in question. If the disease is hypertension then the job is done when the blood pressure reading is normal.
However, physicians like Guyatt have shown that there is no close correlation between biometrics like "lung function" and the health experience of people with chronic lung disease. This is what lead him to develop the Chronic Respiratory Disease Quality of Life instrument.
In fact, the whole field of "Quality of Life" research has struggled to come up ways to capture an idea of health or suffering which really does encompass the whole experience of an individual's life.

Why upgrade to a broadview?
"Evidence Based Medicine" as defined by Professor Sackett has been sadly distorted and is now frequently used as a way of cutting services. Managers do this by claiming to be scientific. They claim that if there are no "randomised controlled trials" to support an intervention then we shouldn't be making that intervention. Aside from the fact that most surgical procedures, psychotherapeutic interventions and even wound dressings, have virtually no "RCT evidence, the basic premise is that the best way to make a decision about health care is to remove the human factors. "RCTs" attempt to "control" for the people involved - the doctors and the patients. Attempting to provide evidence of effectiveness of the technology under study (usually a drug) as if it doesn't matter who the person is who is delivering the technology or who the person is who is receiving it.
This is a very narrow view.

What would a broadview look like?
People would be more important than diseases, technologies or anything which can be measured.
The people who need help, and the people who are there to help.
We would want to know, not will this intervention suppress or remove some aspect of a disease in the short term, but what will the continuing effect be and how broadly will it affect this person?
This isn't complicated. If I am sick, I want someone to help me who cares whether or not I get better and cares to relieve my suffering. Secondly, I want that person to have good technical competencies. If they only have good competencies but don't care, really, they are potentially dangerous and probably will fail to take into consideration the things which are most important to me.

Salutogenesis
In fact, a broader view is how to promote healing - repair and recovery; coping.
A narrow view is how to remove disease or normalise a biometric.
The broader view demands an understanding of "salutogenesis" - how people get well.
The narrow view focusses on "pathogenesis" - how folk get sick.

A health service as if people mattered.
As Don Berwick says in "Escape Fire", health carers exist to care for the sick, and health service managers exist to help health carers to care for the sick.
Why do we so often create systems which are upside down? Where a group of individual managers meet to decide what the sick need and then demand that health carers meet the targets which the "plan" sets. (And how often are those targets actually drawn up according to financial imperatives, rather than health imperatives?)
Let's have a health service where people are the most important element in our thinking - the people who are sick and those who are there to try and help