Professional Models vs. Patient Models in Rehabilitation after Heart Attack

Abstract

Two problems were identified in the professional treatment of rehabilitation after acute myocardial infarction (MI): (1) “Tower of Babel”—the physician, the social worker, and the psychologist use competing models to diagnose, intervene in, and evaluate a rehabilitation process, while each of them accounts for a fraction of the variance of the rehabilitation outcomes. (2) Asymmetry of relations-all three models overlook the possibility that the patients themselves have their own models, and that these models should be considered in the rehabilitation process. In a recent study, 89 male patients, ages 34-60, admitted to the Intensive Coronary Care Unit of the Soroka Medical Center in the south of Israel, were interviewed after their first acute MI. Their choices from a special Q-sort were factor-analyzed, and five consistent models were identified. Two of these patient models accounted for 35% of the variance in a regression analysis of the rehabilitation measures (return to work and physical and sexual functioning) after half a year. Only one of the patient models was based on a professional model. The physicians' model, based predominantly on physical cues, did not account significantly for the rehabilitation measures. Furthermore, when interviewed, most of the physicians were not aware that their patients had such models, and that they should be considered in the rehabilitation process. The results call for a redefinition of the social scientists' role in this medical setting. A system approach is proposed as a possible solution for the “Tower of Babel” problem and the asymmetry of relations between the professionals and their patients.