How illness presents in family practice

Abstract

Family medicine is a very different speciality to secondary care or specialist care medicine. A whole new set of knowledge and skills need to be acquired by the doctor moving from hospital specialist medicine to family medicine in the community. Part of the reason for this is the completely different presentation of illness in a family medicine setting. Traditionally, medicine has dealt with patients and diseases. The common pattern of medicine is that a patient is a person who has a disease. The disease has a cause. If the cause is dealt with, the disease disappears and the patient becomes a person again. Over the past ftfteen years it has become clear that this picture is inadequate to explain many medical consultations. The classic work on this subject was done by Zola in Massachusetts, USA. He showed that what brought people to a doctor was not necessarily a disease at all. Zola's work has been repeated and conftrmed by McWhinney in Canada, Howie in Edinburgh, and other workers in Holland, Sweden, Italy and Finland. Why then do patients present to doctors? What do we mean by illness and what is a disease?