Beyond Diagnosis

Failure to integrate behavioral science with clinical medicine is due to a lack of a schema for classifying patient behavior. A useful system for classifying patient behavior at the point of contact with the physician has five categories: attendance with symptoms or problems that have reached the limit of tolerance; attendance with symptoms that provoke action not because they cause distress but because of their implications; problems of living presenting as symptoms; attendance for administrative reasons; and attendance for reasons other than illness. To fill a similar need for a taxonomy of social factors in illness, another schema for classifying interactions between patients and their environment has seven categories: loss, conflict, change, maladjustment, stress, isolation and failure. These systems, used in parallel with traditional clinical diagnosis, should provide a useful tool for the integration of behavioral science with clinical medicine.