Barriers to Care

Abstract

In elevating cost containment to a first principle, the current political debate about health policy in the U.S. and Canada has lost sight of what should be its primary concern: the health status of the population. The two need not be incompatible. Many current medical procedures are of uncertain value for health and entail sizable costs. The application of the knowledge obtained through randomized clinical trials to the practice of medicine can improve public health and at the same time save money for needed health purposes. Technology has come to dominate medical vision and has created conceptual barriers to responsive medical care. Doctors must attend to the illness experience of the patient as well as disease in organs and tissues. The limits of the biomedical model in psychiatry are illustrated by means of a hypothetical instrument: the PET/NMR cephaloscope. Clinical experience in psychiatry makes it abundantly clear that family and cultural environment are decisive determinants of functional status, even in disease conditions with a major organic component.