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On Diagnosis: A Systemic Approach

John J. Massarelli, MD
JAMA. 1985;253(13):1937. doi:10.1001/jama.1985.03350370133040.
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The title of this book may be misleading to some primary care physicians, in that "diagnosis" refers as much to content as to process, and "systemic" signifies not systems of the body, but systems theory. The author is a family practitioner with a background in psychiatry. From the evidence of this book, he is a thoughtful, compassionate, practical physician who "cares" for his patients in both senses of the word.

As chronic diseases with multiple causes or unknown etiology have become among the most common problems with which doctors deal, the biomedical model of disease is less useful, and a biopsychosocial model is now more valid. The context of a medical diagnosis must take into account "two vast systems": the family system to which the patient belongs and the medical system of the doctor. The doctor-patient relationship is the interaction of these systems, as modified by the social system in


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