Bridging the disease-illness divide in modern medicine.

Department of Psychiatry, Christian Medical College, Vellore 632002, Tamil Nadu, India; [email protected] © The National Medical Journal of India 2009 INTRODUCTION Healthcare in India is at the cross-roads. The increased cost of healthcare is often a major reason for indebtedness among the lower socioeconomic strata of society. The urban-centric nature of our current health systems makes it inaccessible to the large mass of people who reside in rural areas. The free market in healthcare, with its business practices (i.e. commissions paid for ordering diagnostic tests and for prescribing specific treatments and products) and poor regulatory controls have changed the healthcare scenario. In addition, lack of information in the public domain about medical procedures and treatments and their complexities do not allow for an informed choice. The health– hospital, pharmaceutical and medical education industries, which profit from disease and illness, have also complicated the scenario. Self-treatment, family care, self-help groups, religious practitioners, traditional healers and indigenous medicine are often the first and only source of healthcare for many. This has led to divergent perceptions of issues related to health, disease and illness between the medical fraternity and those who seek healthcare. I discuss issues related to the problematic conceptualization of disease and illness which underpins many of these issues. I also attempt to suggest possible solutions to bridge this divide.