Proposing a practical clinical model

Patients experience benefits from stroke rehabilitation while simultaneously confronting frustrating limitations in recovery. Some of these limitations occur beyond the visibility and recognition of physicians and other health care professionals. Kaufman's phenomenological study of boundaries of authority and responsibility in medicine thoughtfully examines factors contributing to these limitations following stroke. One source of boundaries affecting these experiences are the conceptual models guiding the provided care. One is the well-established biomedical model. Biologically nonmeasurable aspects of a patient are left unconsidered. A more holistic model risks condoning medical interventions in nonbiological dimensions of a person's life. Kaufman suggests that conflict between these perspectives can contribute to suffering in the cases examined. This stimulates reflection on what might be done differently. Although not eliminating boundaries between health care and individual's experiences of chronic illness and health conditions, a practical clinical framework, the Siebens Domain Management Model (SDMM), can bridge some of these boundaries. It integrates the biomedical and the holistic biopsychosocial models. The framework is understandable to patients, bridging the gap between the health care providers' and individuals' life worlds. With consistent application over time, the SDMM framework may lessen some care limitations and associated suffering resulting from boundaries described by Kaufman.