Client-oriented medicine

Both weak (Illich) and strong (Kerr White, Cochrane) cases have been made for radical changes in medical education and medical practice. The real needs of patients and of the community are considered to be incompletely served by the prevailing emphasis on acute hospital medicine, to the comparative neglect of primary care in the community and of the needs of particular 'client groups', e.g. the mentally and physically handicapped, and the elderly. Inherent in this approach are emphases on information systems related to morbidity rather than to mortality; on 'care' rather than on 'cure'; on quality control relating to 'outcomes' rather than to 'structure' or 'process' of practice; and on controlled trials of both new and accepted forms of treatment. Difficulties in this approach include the taxonomic incongruity of 'client-group' statistics and the 'disease-system' categories of biomedicine; the therapeutic expectations of the consciously ill; the intellectual interest and the immediacy of specialized clinical practice; and the necessary and profitable links between medical science and the general corpus of science. Nevertheless, and in the full recognition that what is socially desirable may not be scientifically feasible, there is a need in the research context to explore methods of assessing the 'health service priorities' to be attached to biomedical categories. However, these priorities are in themselves multiple, and their relative weighting involves value judgements which are not completely quantifiable.