The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine
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The Hidden Curriculum and Integrating Cure‑ and Care‑Based Approaches to Medicine Divya Choudhury1 · Nico Nortjé2,3,4
© Springer Nature B.V. 2020
Abstract Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the hidden curriculum perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach. Keywords Hidden curricula · Care vs. cure · Formal curricula · Dichotomous · Residents
Dichotomous Language “Cure versus care,” often used in healthcare settings, seems to refer to two different approaches to the practice of medicine. Although there is no precise definition for each approach, De Valck et al. (2001) and Sarto-Jackson (2018), describe * Nico Nortjé [email protected] 1
Lovett College, Rice University, Houston, TX, USA
2
Department of Critical Care, Division of Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA
3
Department of Dietetics and Nutrition, University of the Western Cape, Bellville, South Africa
4
Centre for Health Care Ethics, Lakehead University, Thunder Bay, Ontario, Canada
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HEC Forum
“cure-oriented” or “disease-centered” medicine as based on the biomedical model, which is founded upon the philosophic principles of reductionism, the view that “… complex phenomena are ultimately derived from a single primary principle” (Engel 1977, p. 130). The disease-centered approach focuses on quantifiable physical symptoms and responds to the cognitive need of the patient to understand her disease (De Valck et al. 2001, 2018). On the other hand, Tinetti et al. (2016) and Zhao et al. (2016) refer to the “care-oriented” approach as patient-centered and based on the biopsychosocial model, which prioritizes collaboration between physician and patient, sees the patient as an individual rather than a “disease-carrier,” and takes into account context, including their psychological and emotional health (De Valck et al. 2001; Zhao et al. 2016; Engel 1977; Sarto-Jackson 2018). More concretely, a care-oriented approach involves taking into account factors such as a patient’s mental health, long-term access to health-care resources, support systems, and h
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