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Nursing Model vs. Medical Model

In a growing world of medical careers and opportunities, it can be very daunting and difficult for the prospective student to decide what career is best suited for them. In many cases, the options are numerous and can overwhelm students.

Not only is it not enough for us to know that we want to go into health care, we have to know the type of delivery, method and means that we might explore. With the many different options out there, we may begin to ask ourselves questions, like:

 

What is the nursing model?

How is nursing different from medicine?

Are the routes completely separate or can I start in one and end up in another?

How do we compare nursing vs medicine?

The ultimate question becomes… How do these models compare, and which is the best for me?

 

The bigger picture

In many of our tutoring and advisory sessions with “pre-health” students, we advise students to take a look at the big picture. Health care is a moving, complex, and ever-changing system that affords more and more opportunities for those who choose to delve into it, particularly with the number of career options available. We encourage students to look at the physician assistant career, physician, DO, MD, nurse practitioner, and many others.

 

Physician Assistant

The beauty of the physician assistant application demographic, is that many students have a broad expanse of experience, including experience in nursing, pre-hospital medicine, laboratory science and much more.

 

Nursing

For the student with experience in nursing or a previous career in nursing, the question remains: Should I pursue the nursing model or medical model?

 

What is the difference?

You might begin with a simple question among all of your other responsibilities for the day: Who cares? What’s the point?

We all strive to provide better care to patients and top-notch quality patient education, so what is the difference if you were trained on nursing vs medicine?

 

Approach to patient care

Well, the great thing about healthcare is that our backgrounds afford us different opportunities and our approach to patient care and the art of medicine is a culmination of all we have learned from other sources. So, similar to what we discuss with applying to PA school, it is important for the clinician to have a broad range of diverse experiences that help align their ultimate philosophy on patient care.

 

What is the medical model?

The term “medical model” was first coined by R.D Laing back in the 1970s as a way to explain or quantify the medical practice. It is loosely defined as “the set of procedures in which all doctors are trained”. The idea would be that medical education, medical practice and patient care should be very similar regardless of where the patient is seeking their health care. As health care has evolved, we have seen challenges in relation to the medical model, as it sometimes does not align with modern care.

 

The medical models focus - Cause and Effect

The medical model focuses on cause and effect, in their simplest forms. For example, if we are seeing a 48-year-old patient with a foot ulcer, the medical model would focus on cause and effect, considering the cause of the ulcer and the effect it is having on the body. In its’ simplest form, we are acknowledging the presence of disease and our effect will be trying to treat the disease with an antibiotic.

 

The success of the medical model

In many cases, the medical model has been extremely successful because it is at the basis of what we do as health care providers. As scientists, we investigate the cause (pathophysiology) of a disease, consider its impact on body systems (abnormal labs, abnormal vital signs), and propose a treatment (surgery, anti-biotics). The medical model of science and discovery has yielded numerous advancements in immunology, cancer research, and others, but is it really relatable to patient care?

 

The medical model and patient care

We know from our experience and education that there are numerous things that contribute to the sum of a patient. Stress, lifestyle, family ties, psychosocial constraints, diet, sleep, depression, housing, the list goes on and on. If we truly only focus on the small aspect of anatomy or pathophysiology that is contributing to a patient’s health, we are doing a disservice to our patient.

 

The "older" medical model

The antiquated version of the medical model falls short of good patient care because it does not take into account the “whole person” type of care that patients truly need. That’s why many health systems and health care teams blend the medical model, the nursing model, and social model. The medical model focuses on an evidence-based care approach, which is important in many situations.

 

What should the new graduate do?

As a new graduate, it can be difficult to determine how to use these models in care. When first practicing medicine, it is very easy to become enthralled in the various differential diagnoses that are possible for any given patient. It is also easy to forget about healing-oriented medicine, also known as “integrative medicine,” which takes into account the whole person and puts the patient at the center of their care.

 

What I learned from one of my early encoutners

I can recall a patient encounter early on in my career. It seemed simple at the time. The patient had hypertension. I started him on Lisinopril. He came back for follow up, but his blood pressure was still high….

Let’s stop right there. What’s wrong with this situation? It may seem fairly simple, but in this case, I’m making a huge error as a provider. I’m not thinking about the why. When discussing with the patient, a little frustration came through. I remember saying, “Why is your blood pressure high, aren’t you taking your medicine?” It was simple in my mind. Take the medication, get better.

In this case, I was only looking at one piece of the puzzle. It turned out that the patient could not read and as a provider, this never occurred to me. I did not do an adequate job of explaining to the patient what the medication was for, why he should be taking it, what the risks were associated with the medication and I did not ensure he understood the instructions on how to take it. I’d done a crappy job of doing my job, plain and simple. In this particular case, I was so focused on the one cause and one effect, that I did not take a look at the whole picture.

 

The Social Model

A 2018 paper published in the British Medical Journal indicates that we should perhaps focus ourselves a little bit less on the medical model and more on the “social model” and other factors that are health-determining (such as, stress, diet, literacy, economic status, etc.).

After all, we know that for hypertension, the Renin-Aldosterone-Angiotensin complex is paramount and medications work on this, but there are so, so many more things that contribute to why that patient is sitting in front of you right then, with a blood pressure of 170/110.

 

What is the nursing model?

The nursing model is another model of care that is important for students to experience because it is very different from the traditional medical model and offers opportunities for diverse patient interaction and encounters. In the nursing model, the focus is much more on the whole person approach and looking at the things that impact a patient overall, as a whole.

 

Similarities between the nursing and medical model

It is important to note that the two models also have many similarities. The nursing model quite obviously employs much of the science, experiment and data collection that the medical model does, but also looks at other extraneous factors that might influence care. As technology and medicine have expanded, the medical model has grown to focus also on extraneous factors not previously otherwise appreciated.

 

Ten Curative Factors - the nursing model

According to the University of Rochester, the nursing model has intimate routes with Dr. Jean Watson, a 1970s nurse and educator who looked at the “ten curative factors” which all involve the patient as a person, their family, their social situation as contributors to health (University of Rochester 2020).

 

Psychosocial factors

The social model has also been a significant influence in recent years.  In primary care, we are now transitioning toward much of our visit for routine disease management being aimed at psychosocial factors which contribute to care and health outcomes.  Patients are given depression questionnaires at their visit; they are asked questions about their ability to pay their bills and afford healthy food and their safety in the home.  These questions are paramount to the provider's assessment and treatment plan of the patient, as many times patients will not offer up this type of information unless asked directly.

The whole person approach breaks down numerous barriers to care, giving us an opportunity to intervene in things that traditional medicine might have overlooked.

 

Reflecting on my own experiences

It has taken me a while to reflect on my experiences with both the medical and the nursing model.  Attending physician assistant school at a tertiary care facility with numerous highly funded research laboratories and on the cutting edge of new medical science has allowed me to gain experience with the scientific portion of medicine, as well as being involved in some of the more complicated cases. I was fortunate to still have the opportunity to experience first-hand, how the social and nursing model approach to care were used.

 

Daily rounds and many attendees

In this particular case, during my rotations, our daily rounds would be attended by many different professionals, including:

  • An attending physician
  • Fellows
  • Residents
  • Medical students
  • PA students
  • Nurse educators
  • Social workers
  • Care coordinators
  • RNs

It was a beautiful mixture of education of the disease processes, using cause and effect (medical model), and a plethora of different professionals all working to cover each piece of the medical puzzle; from physical, social, emotional, spiritual (nursing/social model) standpoints.

 

Becoming a well rounded provider

Both the medical model and the nursing model are paramount factors in one’s education and journey to becoming a practicing clinician.  I would recommend that students strongly immerse themselves in a vast variety of topics, gain a vast variety of experiences with different healthcare professionals and members of the team to assure that at the end of the journey, they are competent in the scientific aspect of medicine, but can also employ a "whole person" approach to the patient in front of them.

 

References

BMJ (2018). Medical model of care needs updating, say experts. British Medical Journal.

OCR (2012). Health and Social Care. Cambridge Technicals.

University of Rochester (2020). Nursing Model of Care. Date of access 4 February 2020.

 

This article or blog post should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis of expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog.