Objective and Subjective Perceptions of Health
A well-trained physician, or an observant member of a family, can often tell at a glance that someone is unwell. There are obvious signs—pallor, sweating, unsteady gait, a bone-shaking cough. The converse is more challenging. Someone who appears to be outwardly perfectly fit—hale and hearty, sound in wind and limb—may harbor an early cancer that is eating away at a vital organ, or, when asked the right questions may reveal a potential mental health problem, though there is no physical evidence of a departure from excellent health. Health has many dimensions, and each must be assessed and measured on some sort of scale. This is what physicians do when conducting a routine medical history and physical examination, which includes various laboratory tests. The results of such an examination have a range of values that usually follow a normal distribution, and for many of these the decision that a particular value lies within or outside the range of normal is rather arbitrary, although it is based on empirical experience. For example, experience and follow-up of many sets of observations allow us to agree on what level of systolic and diastolic blood pressure give grounds for a confident recommendation that treatment is needed to reduce an excessively high pressure that could lead to a stroke or heart attack.
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