UMI/ProQuest URL	http://80-wwwlib.umi.com/dissertations/fullcit/3046354
PUBLICATION NUMBER	AAT 3046354
TITLE	A social history of healthcare paradigms
AUTHOR	Bullens, Denison K., Jr.
DEGREE	PhD
SCHOOL	FIELDING GRADUATE INSTITUTE
DATE	2002
PAGES	264
ADVISER	Johnson, Leo
ISBN	0-493-72335-8
SOURCE	DAI-B 63/06, p. 2777, Dec 2002
SUBJECT	HEALTH SCIENCES, HEALTH CARE MANAGEMENT (0769)
ABSTRACT	The dominant paradigm in healthcare is the medical model. In recent years, this model has been criticized as being dehumanizing, impersonal and ignoring the patient as a whole person. Complementary and alternative models have been proposed, and a significant portion of the population has resorted to complementary and alternative medicine. Will the medical model continue in its present form? The objective of this historical inquiry was to gain a better understanding of change in healthcare by studying the history of medicine. Thomas Kuhn's (1970) model of science, described in his essay on <italic>The Structure of Scientific Revolutions</italic>, was used as a methodology. Did medicine develop incrementally in a cumulative process over the centuries as medical texts suggest or did change take place cyclically, as Kuhn avers, via discoveries and inventions of theory stemming from anomalies deviating from the dominant model of the time? Starting with the Greek gods and the legend of Hippocrates in the 5<super> th</super> century BC and continuing to the time of Galen in the 2<super> nd</super> century AD, there was an initial pre-paradigm development stage in healthcare. The Galenic humoral paradigm rose to dominance thereby commencing the second or, as Kuhn calls it, the normal science stage of the Kuhnian cycle. Galenism continued as the normal science until the 16<super>th</super> century when a series of anomalies were broached by members of a scientific community. As these anomalies led to discoveries and inventions of theory, Galenism began to fail, marking transition into the third Kuhnian stage of crisis, extraordinary science and a return to preparadigmatic conditions. Over the next four centuries, new candidates for paradigm emerged and battled for acceptance followed. Finally, in revolutionary fashion, the scientific medical paradigm triumphed early in the 20<super>th</super> century with the germ theory of disease, and a new stage of normal science began. This study concludes that: (a)&nbsp;development in healthcare over 25 centuries happened in the manner described by Kuhn; (b)&nbsp;a third stage of crisis and extraordinary science may again be underway, but resolution may be through change of philosophy and modification of paradigm rather than revolution through integrative medicine; and (c)&nbsp;public input as part of the persuasion process should be added to the Kuhnian model of change.