We Need a New Narrative: Agents instead of Patients

The definition of postmodernity is the failure of the ‘big narratives’, mainly the big narrative of religion and religious salvation [1] , with the result of a thoroughly secular culture [2] , at least in our Western societies. Many people think that this yields a society without any rules and with a ‘philosophy to go’. In fact, it seems that at least in medicine a different narrative has taken over. It is the narrative of the post-modern physical repair shop which can replace broken parts – like hips, knees, hearts – and uses pharmacological fixes for complex internal situations, thus improving the condition of patients [3] . This is a subtheme of the larger narrative of the scientific-rational program to improve our living conditions, at least materially, and as such has achieved a lot, no doubt. Life expectancy is rising, morbidity is compressed in some areas, at least to some degree, at the end of life. Infant and childhood deaths are on the decline [4] . Hence, the figures seem to support this narrative of improvements for patients through scientific means. Modern science has taken over the job of religion to provide a background narrative for our post-modern minds, if not hearts. In medicine, this narrative is the patient story. People with diseases are called patients, and they are supposed to be fixed by evidence-based methods of treatment that have undergone rigid testing. No? Well, partially. The point I wish to make is: this narrative is only useful for some cases, but not for others. It is derived from the grand narrative of improving living conditions and is mainly applicable to standard problems in medicine which arose at the beginning of the medical-pharmaceutical era that can be roughly equated with the demands for emergency medicine by the big wars and the big epidemics of the 19 th and 20 th century. In emergency medicine, we have the biggest historical victories: over pain (through the discovery of morphine and related substances), over infectious diseases (through the discovery of hygiene, vaccination, and antibiosis), as well as over acute emergencies and accidents (through the development of surgical techniques). At this point, medicine started to extend the remit of its narrative from the acute emergency in a helpless patient to all other medical problems, diseases, and illnesses, and this is where the problem originated. The major challenges of our post-modern era are not necessarily analyzable in the same way. They are not about medical emergencies, where a repair-shop mentality can be set to work to fix broken limbs, hearts, and immune systems. Most of our modern-day problems are chronic, complex, functional, psychosomatic, or psychosocial in nature [5] . And more than 70% of the ‘patient’ load in a general practitioner’s consulting room are of a functional and complex kind and cannot be dealt with through such a narrative of patients in need of repair [6, 7] . Typically, the contemporary big killers in our societies – coronary artery disease with myocardial infarction and stroke, cancer, and the big threats like inflammatory neurodegenerative diseases, such as dementias, Alzheimer’s, Parkinson’s, or Published online: November 23, 2018