The Sickness Impact Profile: The Relevance of Social Science to Medicine

Abstract

The past decade has been a period of rapid growth in the representation of social sciences in the curriculum of medical education. The social ferment of the 1960’s precipitated an enormous interest in the health of disadvantaged individuals and social groups. Awareness of the importance of social and economic factors as determinants of the health levels of individuals and groups became acute. Further, the discrepancies of access to health care associated with social, economic and cultural factors became clear. Students were outraged that these injustices had not been previously recognized and corrected. Curriculum “reform” became the by-word of the day and an important part of the reform was to consist of enhancement of the role of social, especially behavioral, sciences in medical teaching and practice. New faculty members were recruited, new courses were developed, and whole new departments sprang into being. Students and faculty alike were urged to view the patient as a “whole person” and terms such as holistic medicine, comprehensive care, continuity of services began to appear frequently in medical literature. Simultaneous with the increased awareness of social factors as determinants of health in disadvantaged groups came an awareness of many unsatisfactory aspects of the health care system for all segments of society. Increased specialization and fragmentation of medical care as it was delivered by many specialists and sub-specialists to a single individual led to the conviction that no one was keeping an overall eye on the health problems of any one person. The concept of a new type of health care provider, the family physician, grew rapidly; (s)he was to be a felicitous combination of the attributes of the old general practitioner and the skills of the most common aspects of internal medicine, pediatrics, obstetrics-gynecology, and psychiatry. Great emphasis was placed on the physician’s understanding of individual and family behavior. Increased recognition was given to the restoration or maintenance of individual and family function as a legitimate product of the process of medical care.