Towards a definition of holism.

At the recent World Conference of Family Doctors (WONCA) meeting in Orlando, I attended a session of presented papers related to medical education. One examined the degree to which Swedish GPs felt that a holistic approach was important to their work. Curiously, this paper was labeled in the programme as not eligible for CME credit. During the questions period, one attendee suggested that CME was not allowed because the programme committee had considered holism in the title to mean it was about alternative medicine, and thus not scientific. This raises a number of questions because, as the authors noted, the motivation for the study was that ‘holistic modelling’ is one of the ‘six core competencies of the GP/family doctor’ identified by EURACT, the European Academy of Teachers of General Practice, in 2002. Why would a paper containing one of the core competencies in its title be presumed to be about alternative medicine, or otherwise not of value? (Not to mention why a paper that was on alternative medicine would be presumed to be non-scientific and unworthy of CME credit.) I suggest that at least part of the reason is that many different definitions of holism, and holistic, are being used in health and the healthcare literature, and no one is quite sure what anyone else means when they use these terms. Certainly, a brief review of the medical literature suggests that there are multiple understandings of holism — it is used for a variety of approaches that come under the heading of ‘complementary’ or ‘alternative’ medicine, spirituality in health, nursing practice, and the more compehensive style of allopathic care suggested by the biopsychosocial model of George Engel, now widely accepted in the general practice community. The term is most common in non-biomedical journals, but also appears in more ‘mainstream’ journals, such as BMJ, British Journal of Nursing and Pediatrics. Definitions, however, are much harder to find; each author seems to presume an understanding by the reader of its meaning, despite the wide variations in usage. The term ‘holism’ is generally conceded to have been coined by the South African Jan Smuts in 1926. The Oxford English Dictionary definition is ‘the tendency in nature to form wholes, that are greater than the sum of its parts, through creative evolution’. Comprising a philosophical approach beyond medicine and health, holism developed into a variety of schools in the inter-war period. The impact of these approaches on medicine is examined extensively in the collection Greater than the Parts: Holism in Biomedicine edited by Christopher Lawrence and George Weisz. A response to reductionism, particularly biological reductionism in medicine, Lawrence states that: