From risk factors to health resources in medical practice.
The healing and preventive powers of people's health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this article, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine. Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter. By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are briefly presented as examples of empowerment through dialogue.
Hollnagel
H
H
Research Unit and Department of General Practice, University of Copenhagen, Panum Institutet-Blegdamsvej 3, DK-2200, Copenhagen N, Denmark.
Malterud
K
K
D003142:Communication; D004812:Epidemiologic Methods; D004992:Ethics, Medical; D005194:Family Practice / Q000592:standards*; D005610:Freedom; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006694:Holistic Health; D006801:Humans; D007258:Informed Consent; D018802:Patient-Centered Care; D011209:Power, Psychological; D012307:Risk Factors; D012647:Self-Assessment