This article contrasts the assumptions and concepts of two distinct approaches, the medical model and Parse's human becoming theory, as applied in a nurse-managed capitated community healthcare program for older adults. Many nurses incorporate aspects of the medical model into their practice without fully appreciating the implications or being aware of alternative perspectives. Within capitated health programs a nursing practice based on a nursing theory which emphasizes an intersubjective dialogue with older adults as they move toward different meanings and free choice is seen as more likely to be associated with greater satisfaction and reduced healthcare expenditures than a nursing approach based on the medical model, which relies on the objectification of human experience. Nurses can best balance the problem-focused orientation of a medical model dominated healthcare system by adopting an approach committed to recognizing that persons are the coauthors of their existence.
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