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healthcare model

What's in a word?
Defining well-being

care health soundness attention well-being oversight healthcare

From the "problem-oriented" perspective, healthcare consists of providing close attention and painstaking application of knowledge to the solution and/or resolution of the patient's health problems. This view stems from defining health as soundness and a health problem as loss of soundness. The next definition of health, well-being, reveals an alternative, complementary view. At first it might seem that well-being and soundness amount to nearly the same thing, but grammar and etymology open up a whole other way of looking at health and healthcare.

Circular definitions

health *: 3. A condition of optimal well-being.
well-being *: The state of being healthy, happy, or prosperous; welfare.

care for the well-being of the patient The third definition of health would appear to be a tautology. Well-being is defined as the state of being healthy, and healthy is possessing good health. Substituting,

health becomes a condition of possessing optimal good health, and
well-being is the state of possessing optimal well-being,

circular reasoning in both cases. Finding a way out of this circularity requires a closer look at well-being and especially the word well.


Adjective or adverb?

Well* is among the most versatile words in the English language with over thirty dictionary definitions, performing in the roles of noun, verb, adjective, adverb, and interjection, as well as in several well-known idioms. The tautology demonstrated above is due to the second definition of the adjective well (Table 7): not ailing, infirm, or diseased; healthy. The first adjectival definition (in a satisfactory condition; right or proper), however, provides a more ancient and broader sense closely related to the adverbial definitions (Table 8). From the earliest Old English, well has been an adverb of approval or commendation: satisfactorily—in a manner (or to an extent) that gratifies or fulfills a need, desire or expectation.

Table 7. Adjectival Senses of Well *
1. in a satisfactory condition; right or proper
2.a. not ailing, infirm, or diseased; healthy
2 b. cured or healed, as a wound
3.a. advisable; prudent
3.b. fortunate; good
is well, exists well
being well, being well
Table 8. Adverbial Senses of Well *
Synonym Example
1. properly correctly behaves well
2. skillfully proficiently dances well
3. satisfactorily sufficiently slept well
4. successfully effectively gets along well with
5. comfortably affluently lives well
6. beneficially advantageously married well
7. reasonably fairly can't very well say no
8. likely probably may well need an umbrella
9. prudently sensibly would do well to say nothing
10. familiarly closely knew them well
11. favorably approvingly spoke well of them
12. thoroughly completely well cooked, well rested
13. perfectly clearly well understood
14. suitably appropriately well pleased
15. considerably quite well over the estimate
16. carefully attentively listened well
17. entirely fully well worth seeing

-being is the gerund form of the verb to be, which can express either identity or existence. In the first case, to be is a copula linking the predicate of a sentence with the subject; in the latter it is simply an intransitive verb. Thus the well in well-being could be an adjective complement or an adverb. In similar situations, we typically think of well as an adjective. Consider, for example, the following sentences.

In S1 and S2, the verb to be links the quality of being well with the subject ('she'). In S3 and S4, the present participle and the gerund take on the same role, so that in all four sentences well is an adjective. For example, one may substitute obvious adjectives like red or tall with no harm to the syntax. More to the point, well is synonymous here with the adjective healthy, but not with adverbs such as properly or fully. The main difficulty in viewing well in well-being as an adverb is that we do not typically think of being (existing) as something that one does either poorly or well. One simply exists or not. The following sentences, for example, seem awkward if not downright improper.

But consider the following substitutions:

In S5b, the adverbs properly and fully have been substituted for well. In S6b-S8b, well is an adverb, for which properly or fully can be substituted both grammatically and logically. The point is not merely that well can function grammatically as an adverb, however, but that the adverb well can logically apply to being. Without stretching the imagination far, the participle, gerund and verbs modified by well in S6b-S8b may be considered extensions of the verb to be, to exist, to live and breathe, to function as.

Now consider the following sentences.

We could invent a dozen scenarios in which sentence S9 might apply: a street urchin stealing food, a soldier leaving for war, a baron making out his will, a laborer enduring an oppressive job. The list is endless, but in every case it is clear that what "he" had in mind is not merely a state of good health (though this may be involved). What "he" had in mind is a better, more secure, more comfortable, or more satisfying way of life for his family. This sense of the word well does not depend on the altruism of the subject nor on the pleural object (family). Reading sentence S10, we do not necessarily assume that the selfish, singular subject of this sentence is concerned about avoiding illness or injury, although this may be precisely what he had in mind. We are more likely to suppose that he desires his own improvement, security, comfort or satisfaction. He wishes for a better way of life, a more gratifying manner of being.

We are now ready to demonstrate how the words well and will are related, and to define well-being as existing as one wills. Not that anyone is ever able to exist entirely "as one wills," but what existing well means is clearly related to the meaning of the will.

Where there's a will...

The force of my argument does not hinge entirely upon insisting that the well in well-being is an adverb, because in either case (adjective or adverb) well clearly carries the adverbial flavor found in adjectival definitions 1 and 3 (Table 7) and as expanded in Table 8. These definitions produce a dense, tightly woven semantic network (Table 9), a set of words whose definitions consist almost entirely of other words in the same set: verbs such as satisfy, gratify, fulfill and please, nouns such as needs; wants, desires and wishes.

Table 9. Dense Semantic Network
Surrounding Well and Will
commend to express approval of
approve to speak favorably of; to consider desirable
favor to be partial to; to desire; to find pleasing
satisfy to fulfill a need; to gratify the desire of
fulfill to measure up to; to satisfy
gratify to please or satisfy
please to be the will or desire of
will to choose; to yearn for; to desire
desire to wish or long for; to want
wish to long for; to want
long to have an earnest heartfelt desire
want to desire greatly; to wish for
wish to have or feel a desire
gratify to give what is desired
commend to represent as desirable
Table 10. Derivatives of the IE Root
[wel-] *, To Wish
will * Middle English willan,
from Old English willen
well * Middle English wel,
from Old English wel
weal * Middle English wele,
from Old English wela
wealth * Middle English welthe,
from Old English wela
velleity * New Latin from Latin velle
volition * French from Medieval Latin
from Latin velle
benevolent * Middle English from Old French
from Latin velle

The common denominator among these words and their definitions is the sense of volition. Volition * comes from the same ancient root as that of well and will. At the lowest level of volition is velleity *, a mere wish or inclination. At the other end of the spectrum is will itself: (1) deliberate choice or decision, (2a) determination, (2b) self-control, (3) purpose, (4) intention, (5) free discretion.

Some of these definitions imply weighing or tasting (testing). Deliberate (from the Latin libra, balance, scales) means having been weighed, having been considered. Choice comes from an Indo-European root meaning to taste ([geus-] *, also gusto, disgust). Other defininitions of will carry the sense of separating (discretion), cutting (decision * from [kae-id-] *, also precise, concise and the familiar medical words excise, incision and circumcision), or setting boundaries (determination). The final common pathway is limiting options, removing alternatives, reducing uncertainty.

Goal-oriented view of healthcare

These definitions, and more especially the connotations intention and purpose, give rise to a goal-oriented view of healthcare. Intend is genetically related to the verb attend investigated earlier (Defining attention). Both words literally mean to stretch toward, but whereas attention is often demanded by the object of attention, intention arises from within the subject. Through an act of the will, an individual deliberately chooses a concrete or abstract object from among alterntives. Purpose * (literally to put forward, pose and pur-) means the result that is intended, or the object toward which one strives, an aim or a goal. When we define health as well-being, and well-being as existing as one wills, we arrive at a goal-oriented view of healthcare. Healthcare becomes the providing of care for the life goals of the patient. This definition may include restoring or maintaining soundness, but it goes much further than this.

A key synonym of purpose or goal is aspiration. To aspire * to a particular goal is to desire it strongly. The word aspire comes from the Latin word for desire, from the Latin verb spirare, to breathe (also respiration, inspiration). The Latin noun spiritus (English spirit *) originally meant breath, but gradually took over the sense of soul (breath of life). Incidently, the Greek word pneuma *, wind, breath is often translated spirit. The goal-oriented view of healthcare thus includes the spiritual aspects of health and the dignity of human aspirations. On the flip side, human desires and appetites often go awry leading to addictions and loss of self-control. Providing care for health means addressing this aspect of the human condition as well.

The difference between the problem-oriented and goal-oriented views of healthcare can be understood as the difference between mitigation and promotion. To mitigate means to alleviate, to relieve. These words, in turn, come from the root [legwh-] *, light, having little weight, in other words, to lighten the burden. Mitigate itself comes from two Latin roots that literally mean to soften the blow. To promote, on the other hand, literally means to move forward, in other words, to help move toward a goal. Health-related goals and health problems are not mutually exclusive, of course, but promoting goals goes beyond mitigating pain and suffering (as important as the latter aspect is).


Redefining patient

patient * adj. 5: Capable of calmly awaiting an outcome or result;
not hasty or impulsive.

The noun patient (Defining patient) has connotations of suffering that imply a problem-oriented view of healthcare. care for the well-being of the patient one In pondering what word we might use to name the person (or role) that receives goal-oriented healthcare, the idea of using patient as an adjective came to mind. Few goals are reached overnight; some take a lifetime to achieve. Well-being shall come to the patient (ones), and they that wait shall be renewed.


 

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