Models of disability

Models are a practical approach to moving from theory to reality and a means of aiding understanding, research and management. There are strengths and limitations in adopting the traditional ‘medical model’. Social models and the role of personal and psychological factors provide a better understanding of sickness and disability. They also impact on capacity for work and developing interventions aimed at facilitating return to optimal function and thus work. A biopsychosocial model of human illness that takes account of the person, their health problems and their social context has profound implications for healthcare, workplace management, and social policy.

The medical model

The medical model may be summarized as a mechanistic view of the body, in which illness is simply a fault in the machine that should be fixed.

This approach was originally, and is still primarily, a medical treatment model. Its focus on biological pathology and its treatment,31 also leads it to be described as a disease model or biomedical model. Medical treatment is often regarded inappropriately as more or less synonymous with healthcare. This model has led to dramatic medical advances: it has worked well where it is possible to identify biological pathology for which there is effective treatment.32 More generally, the medical model often leads to the assumption that all symptoms mean injury or disease, and that healthcare to ‘cure’ the symptoms is the (only) route to return to work.

The medical model underpinned modern workers’ compensation and social security systems. Once treatment was complete, longer-term support would depend on the severity of permanent impairment, after allowance for rehabilitation and individual adaptation. The traditional occupational health paradigm viewed work as a potential hazard with the risk of occupational injury or disease.

Currently, the medical model remains deeply entrenched in the way that most people think about symptoms, disability, and healthcare. Common health problems are erroneously seen as medical problems that are a matter for healthcare, often caused by ‘injury’ and often work-related. Moreover symptoms are taken to imply incapacity, so sickness absence is considered necessary and justified until full recovery and complete relief of symptoms.

The weakness of the medical model is that it fails to take due account of the patient or their human qualities and subjective experiences.33 The patient’s accounts of illness are reduced to a set of simplistic symptoms and signs of disease.34

The problem is that focusing on disease and its treatment often leads to neglect of the person and the management of the health problem.

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