From “The Disease in the Person” to “The Person with the Disease”: A Paradigm Shift
“Person-centered care” is one of the defining characteristics of general practice. General practice has shifted from the traditional biomedical focus on “the disease in the person” to studying “the person with the disease,” while expanding its scope to include healthy individuals. General medical care values the person over the disease. It restores the patient to a living, feeling, and unique individual, rather than merely a carrier of pathology. Its service objectives encompass not only the diagnosis and treatment of diseases but also disease prevention and health maintenance. General practitioners (GPs) fully consider and respect individuals’ physiological, psychological, and social needs. Through humanized services, they mobilize patients’ initiative, encouraging active participation in the entire process of health maintenance and disease control, thereby achieving optimal service outcomes. — Excerpted from Introduction to General Practice, edited by Wang Zhong
I am deeply drawn to many concepts within general practice, such as the holistic, “person-centered” perspective, the forward-looking vision that expands the target population from “patients” to “healthy individuals,” and the integrated service approach that combines prevention, treatment, and rehabilitation. Among these, the profound implementation of the “Five Star Doctor” concept best exemplifies the unique value of general practice—it is the critical pathway from focusing on “the disease in the person” to “the person with the disease.”
I. The Five Star Doctor: WHO’s Role Expectations for General Practitioners
In 1992, experts from the World Health Organization (WHO) introduced the concept of the “Five Star Doctor,” painting a new picture of the physician’s role. This concept explicitly states that doctors should not merely be “disease treaters”; rather, they must assume multiple roles in their professional practice: healthcare providers, medical decision-makers, health educators, community health advocates, and health service managers.
These five role requirements align perfectly with the core “person-centered” philosophy of general practice. When the gaze of medicine shifts from the “disease” to the “person,” doctors naturally refuse to be satisfied with merely prescribing medication or performing surgery. They must step into the community to advocate for health policies (community health advocates), educate residents on disease prevention (health educators), coordinate and allocate primary care resources (health service managers), make wise clinical decisions that balance individual and population needs (medical decision-makers), and ultimately provide comprehensive, continuous healthcare services for everyone (healthcare providers).
The significance of the Five Star Doctor concept lies in its global perspective, endowing GPs with a mission that transcends the traditional role of “seeing patients and prescribing drugs.” It transforms “person-centered care” from a mere slogan into an actionable and evaluable practice framework. When doctors are required to simultaneously fulfill these five roles, their focus naturally expands from “the disease this person has” to “the person themselves”—their life, their family, their social environment, and their health needs. This is the specific manifestation of the shift from “the disease in the person” to “the person with the disease” at the level of the physician’s role.
II. Three Levels of Prevention: The Core Pathway for Five Star Doctors
Ancient Traditional Chinese Medicine placed great emphasis on “treating before disease manifests” (preventive medicine), considering it the highest level of medical proficiency, attainable only by “superior physicians.” The Lingshu (Spiritual Pivot) of the Huangdi Neijing (Yellow Emperor’s Inner Canon) states, “Superior physicians treat diseases before they manifest, not after.” The Suwen (Basic Questions) also notes, “The sage does not treat diseases that have already manifested but those that have not; he does not govern disorder that has already occurred but prevents it. This is what is meant. To administer medicine after a disease has developed, or to govern disorder after it has arisen, is akin to digging a well when thirsty or forging weapons when battle is imminent—is it not too late?”
When first studying medicine, one might dismiss these words as grand but useless platitudes. However, after more than two decades of clinical practice, if we are willing to settle down and reflect, we will gain a profound, personal understanding of this passage. The more patients we treat, the more tense the doctor-patient relationship becomes. Doctors’ personal safety is hard to guarantee, and the sense of professional fulfillment we derive from this career diminishes, leading many to experience burnout. Under such a model, not only do patients fall ill, but the doctors treating them also struggle to safeguard their own health and safety.
What was our original intention in studying medicine? Was it to eventually develop a deep aversion to this profession? Was it to live in constant anxiety during our commute to work and return home utterly exhausted? Was it to face endless medical records, unceasing conversations, and perpetual informed consent forms? Informed consent forms are merely a legal shell; they are only effective for patients willing to pursue legal proceedings. For those who are not, these forms are nothing but waste paper.
Humanity invented medicine to promote physical and mental well-being. Viewed from this fundamental purpose, the health-promoting efficacy of a scalpel is inferior to that of preventive medicine.
Within the modern preventive medicine framework, disease control is divided into three levels, forming a “three-tier protective net” that covers the entire process of disease occurrence, development, and outcomes. General practitioners are precisely the core weavers and guardians of this protective net at the grassroots level. The five roles of the Five Star Doctor have clear projections in every aspect of the three levels of prevention.
(I) Primary Prevention: Preventing Disease Before Onset, Building the “First Dam” of Health
Primary prevention, also known as etiological prevention, is the most proactive, cost-effective, and efficient component of the three-tier system. Its core philosophy is “prevention is better than cure”—eliminating or reducing the impact of pathogenic factors on the human body at the source before the disease even begins to sprout.
For GPs, primary prevention is woven into every detail of daily services: conducting health education in the community to help residents establish healthy lifestyles, including balanced diets, regular exercise, smoking cessation, limited alcohol consumption, and psychological balance; implementing vaccination programs for eligible populations to build immune barriers; focusing on high-risk groups by providing early interventions and lifestyle guidance for individuals with chronic disease family histories, obesity, or prehypertension; and improving living and working environments to reduce exposure to harmful substances.
In this phase, GPs simultaneously act as health educators and community health advocates. They not only tell residents “what to do” but also actively promote community environments and policies that support health. The target of primary prevention is healthy individuals, which perfectly embodies the general practice concept of “expanding the research subjects to healthy people” and fulfills the Five Star Doctor’s mandate to “step out of the clinic and into the community.”
(II) Secondary Prevention: Early Detection and Treatment, Capturing the “Clues” of Disease
Secondary prevention, also known as preclinical prevention, is centered on the “three earlies” principle: early detection, early diagnosis, and early treatment. For infectious diseases, it also includes early reporting of outbreaks and early isolation of patients, following the “five earlies” principle.
Many chronic diseases and malignant tumors exhibit almost no obvious symptoms in their early stages. By the time patients feel unwell and seek medical attention, the diseases have often progressed to the middle or late stages, significantly increasing the difficulty and cost of treatment. Secondary prevention aims to capture these early signals of disease within this critical “window period.”
GPs are the ideal practitioners for conducting periodic health check-ups and screening high-risk populations. Through regular physical examinations, blood pressure and blood glucose monitoring, and cancer screenings, GPs can identify potential health issues before symptoms appear, allowing for timely intervention to halt disease progression.
For example, if a seemingly healthy middle-aged adult is found to have “prediabetes” during a check-up, a GP can potentially help reverse this trend through dietary guidance, exercise prescriptions, and regular follow-ups, preventing the development of clinical diabetes.
In this phase, the GP acts as a medical decision-maker. Based on comprehensive assessments, they determine who needs screening, when to screen, and how to intervene, ensuring that limited medical resources are allocated where they are most needed.
The target of secondary prevention is the population that appears healthy but harbors hidden risks. This requires GPs to possess keen observation skills and comprehensive assessment capabilities, truly shifting their focus from “diseases that have occurred” to “diseases that are forming.”
(III) Tertiary Prevention: Preventing Disability After Onset, Safeguarding Dignity and Quality of Life
Tertiary prevention, also known as clinical prevention, targets patients who have already been diagnosed. Its goal is not necessarily “cure”—as some diseases are indeed incurable—but rather preventing disease deterioration, avoiding complications and disabilities, maximizing functional recovery, and improving the quality of life through standardized treatment and rehabilitation management.
Within the general practice framework, tertiary prevention goes beyond prescribing medication and performing surgeries; it includes long-term chronic disease management, personalized rehabilitation training, psychological counseling, and social support. After a stroke patient is discharged, a GP will continuously monitor their blood pressure control and medication adherence, coordinate physical and speech therapy, pay attention to their psychological state, guide family members in acquiring caregiving skills, and help the patient reintegrate into family and community life.
In this phase, the GP plays a dual role as both a healthcare provider and a health service manager. They not only provide medical services but also coordinate and integrate rehabilitation resources and social support networks, ensuring that patients receive continuous and comprehensive care. The target of tertiary prevention is “the person with the disease”—a complete individual with emotions, social roles, and life needs. The GP focuses not only on “whether the disease is cured” but also on “how well this person is living.”
III. When Medicine Only Sees the “Disease”: Why Doctor-Patient Trust Drifts Apart
In recent years, the doctor-patient relationship has frequently become a focal point of public concern. While incidents of violence against doctors are heartbreaking, what is even more thought-provoking is: Why do doctors and patients, who should be “comrades in the same trench,” often find themselves on opposite sides?
The answer perhaps lies in the distinction between “the disease in the person” and “the person with the disease.”
When the gaze of medicine focuses solely on “the disease in the person,” the diagnostic and treatment process easily devolves into a cold assembly line: registration, queuing, testing, prescribing, and ending. Patients walk into the consultation room carrying anxiety and fear, only to face a “technical system” that focuses exclusively on lab results and imaging reports. Doctors have no time to listen to patients’ concerns, and patients feel neither respected nor understood. Under this model, doctors see the “disease,” while patients feel the “coldness,” making trust impossible to establish.
The Five Star Doctor concept precisely identifies the crux of the problem: When doctors are positioned merely as “disease treaters,” neglecting their comprehensive roles in health education, community advocacy, and resource management, the doctor-patient relationship inevitably becomes utilitarian and transient. Patients perceive a “one-time transaction” rather than “continuous companionship and care.”
The root of many doctor-patient conflicts is not technical errors but a lack of humanistic care. Patients need more than just a diagnostic conclusion; they need someone willing to listen, explain, and accompany them. When medicine degrades into pure technical operations, and patients are reduced to a medical record, a bed number, or a set of data, alienation and distrust inevitably breed.
IV. From “The Disease in the Person” to “The Person with the Disease”: The Fundamental Path to Rebuilding Doctor-Patient Trust
The “person-centered” approach advocated by general practice, along with the role framework of the Five Star Doctor, is precisely the key to resolving this dilemma.
Shifting from “the disease in the person” to “the person with the disease” means that doctors no longer merely ask, “Where does it hurt?” but further inquire, “What is your life like?” “Can your family support your recovery?” and “Where do your fears and anxieties stem from?” This shift in perspective allows medicine to return to the connection between human beings.
The five roles of the Five Star Doctor provide specific guidelines for action to foster this connection. In primary prevention, GPs enter the community as health educators and advocates, establishing long-term health partnerships with residents—not just “seeing them when they are sick,” but “seeing them when they are well.” Trust naturally grows through daily interactions. In secondary prevention, acting as medical decision-makers, doctors provide continuous health monitoring and follow-ups, making residents feel that “someone cares about my health,” rather than “someone only steps in when something goes wrong.” In tertiary prevention, as healthcare providers and health service managers, doctors offer long-term companionship and comprehensive care, making patients feel they are not fighting alone but are supported by a trustworthy team.
This medical model, based on long-term relationships, comprehensive care, and proactive services, fundamentally transforms the interaction between doctors and patients—shifting from “one-time transactions” to “continuous companionship,” from “passive seeking of medical care” to “active cooperation,” and from “mutual distrust” to “mutual entrustment.”
V. From Concept to Practice: General Practitioners as the Best Practitioners of Three-Level Prevention and the Five Star Philosophy
The three levels of prevention are interconnected and progressive; none can be omitted. Similarly, the five roles of the Five Star Doctor are not isolated but are mutually synergistic and supportive. Due to the broadness of their target population, the continuity of their services, and the comprehensiveness of their approaches, GPs are naturally the best executors in implementing three-level prevention at the grassroots level and rooting the Five Star philosophy in primary care.
From health promotion for healthy populations in primary prevention, to early screening for high-risk groups in secondary prevention, to long-term management and rehabilitation support for patients in tertiary prevention, the work of GPs spans the entire life cycle of disease occurrence and development, covering the whole process from health to disease to recovery. Every role of the Five Star Doctor is fully manifested in this full-cycle service.
This is the profound meaning of the shift from “the disease in the person” to “the person with the disease”: We no longer stare solely at a specific organ, a specific indicator, or a specific diagnosis. Instead, we cast our gaze upon a complete, warm individual situated within a specific living environment. We use the philosophy of three-level prevention to guard them before disease occurs, discover them when disease sprouts, and accompany them when disease takes hold. We hold ourselves to the standards of the Five Star Doctor, striving to be not only healers but also health educators, community advocates, and resource managers.
When we truly “see” the person, the seemingly insurmountable chasm between doctors and patients will quietly dissolve within this act of seeing and understanding.
The essence of medicine has never been merely to fight disease; it is to safeguard humanity. General practice interprets this essence vividly through its “person-centered” philosophy, the practice of three-level prevention, and the role framework of the Five Star Doctor.
These are my reflections from studying general practice and preventive medicine. My initial interest in medicine stemmed from my mother’s illness during my childhood, coupled with my admiration for our village’s “barefoot doctor.” He was a loud-voiced, optimistic, and cheerful man who was a bosom friend of my father.
In fact, the “barefoot doctors” in China during the 1970s and 1980s played exactly the role of general practitioners. They were highly regarded in the village. Their relationship with their patients was not only a doctor-patient relationship but also a neighborhood relationship. In large villages where people of the same surname lived together in clans, doctors and patients even had blood ties. Doctors did not exploit patients through excessive treatment, nor did patients harbor resentment toward doctors; the doctor-patient relationship was highly harmonious.
That was my ideal professional model. However, with societal changes, it is extremely difficult to return to that era. Nevertheless, I have always kept this working model close to my heart.
My current situation and future aspirations closely resemble this working model. For a long time, I have been conducting medical science popularization through my self-media platforms, cultivating a readership of over 100,000 people.
Among these readers, about 5,000 to 6,000 have formed long-term relationships with me, and approximately 1,000 to 2,000 regard me as their family doctor. When they encounter any issues, they consult me first, and we get along very well. I am weary of complex interpersonal relationships and prefer simple, harmonious, and enduring connections with others; thus, this medical model aligns perfectly with my personality.
I believe my most important task in the future is to implement this Five Star Doctor philosophy within this community. By forming a harmonious whole with them, I can safeguard their health. In a way, this fulfills my childhood dream of becoming a doctor.
Through studying general practice and preventive medicine courses, I have gained a clearer understanding of my future professional characteristics. This can undoubtedly be considered one of my greatest gains from attending university.