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Language shapes the way we think, and determines what we can think about.

—Benjamin Whorf

*Mr. Ketterman's Case

Mr. Ketterman has just told me 90 years worth of medical and social history. He has so many problems I just don't know how to organize my thoughts! (See Appendix for Mr. Ketterman's health history.)

As human beings, we use language, all kinds of language, to communicate with each other. We speak of verbal and nonverbal language; of written, oral, sign, and symbolic languages; of languages of different peoples, countries, and times. Each occupation has also developed a language that describes the tools, the processes, and the products of that occupation. Some of these languages are easily translated or understood by those outside the occupation; others become more complex, perhaps even obscure and can sometimes serve to exclude others. But these languages occur for good reason—they serve to provide the framework for a way of thinking, for clarifying and articulating the lens used by its members to view the world. We are not speaking here of the many abbreviations, acronyms, or eponyms that have cropped up in the vocabulary of health care practitioners, but of the basic language that defines the philosophy of practice. There are at least two central components of a useful language of practice. We need to be able to describe our patients and then to describe the process and outcomes of our care for these patients. This chapter will present systems based on the biopsychosocial model to describe our patients and a patient management model that describes the process of our care.


Accurate and comprehensive descriptions of patients are essential. The descriptive label given a patient can help us not only as health care practitioners but as sociologists, health services researchers, and others, striving to understand the concepts of health and illness and what they mean in human life. In this instance the label serves as shorthand for explaining the natural progression of the specific patient and the general condition of groups of people. A label also can help us choose proper interventions and predict outcomes for our patients. In this instance the descriptive label serves as a diagnosis.

The Biopsychosocial Model

The World Health Organization (WHO) has defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."1 Since it was adopted in 1946, this definition, while presenting an ideal, has permeated much of the discussion on health care. It served as the foundation for the overarching model for understanding health and illness known as the biopsychosocial model (Fig. 1-1).2 This model assumes that the person's response to any state of health or illness is a result of the interaction of the person's psychology and social environment with the biological determinants of ...

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