FROM HEALTH RESOURCES TO RISK FACTORS IN MEDICAL PRACTICE
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In medicine, the preventative and curative potential of individuals' health resources and self-assessed knowledge has been grossly undervalued to date. This article draws attention to ethical and epistemological quandaries that are inherent in the prevalent risk-oriented epidemiology and concern communication, autonomy, knowledge, and values. To promote a more equitable distribution of resources and risks in medicine, we propose a patient-centered salutogenetic approach. Identifying and intervening in risk factors can generate hypotheses regarding the origins of disease, as well as facilitate the prediction and, in some cases, prevention of group-level illness. In the individualised context of the clinical encounter, this viewpoint has a number of drawbacks with regard to causal factors, group-level possibilities, adequate endpoints for intervention, informed consent, and medicalization. By presenting a salutogenic viewpoint, we advocate for a reorientation of focus towards strengths, resources, and agency, which have the potential to mitigate disease risk and empower the individual. Both empowerment and oppression can be mediated through dialogue. Brief illustrations of empowerment through dialogue are provided, including self-assessed health resources and a communicative key question approach.
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