A General-Practice Perspective: The Shift from "Disease of a Person" to "the Person with a Disease"
"Person-centeredness" is one of the defining features of general practice. General practice has shifted from studying "the disease of a person" in the old biomedical sense to studying "the person with a disease," and has extended its object of study to healthy people. General-practice care values the person over the disease; it restores the patient to a living, feeling, individual person, not merely a carrier of disease. Its service goal is not only to diagnose and treat disease but also to prevent disease and maintain health. The general-practice doctor fully considers and respects the person's physical, psychological, and social needs, using humane service to mobilize the person's initiative so that he actively participates in the whole process of health maintenance and disease control, thereby achieving good service outcomes.
—Excerpted from Introduction to General Practice, edited by Wang Zhong
I like many of the ideas in general practice: the holistic, person-centered view; the forward-looking vision that extends the population served from "patients" to "healthy people"; and the service approach that integrates prevention, treatment, and rehabilitation. Of these, the one that best embodies general practice's unique value is its deep practice of the "Five-Star Doctor" ideal—and this is precisely the key path from "the disease of a person" to "the person with a disease."
I. The Five-Star Doctor—WHO's Expectation of the General-Practice Doctor's Role
In 1992, experts from the World Health Organization (WHO) proposed the concept of the "Five Star Doctor," painting a new picture of the physician's role. This idea makes clear that the physician should not merely be a "disease treater" but should, in professional practice, carry multiple roles: care provider, decision-maker, educator, community health advocate, and service manager.
These five role requirements align closely with general practice's core, person-centered idea. When medicine's gaze shifts from "disease" to "person," the physician naturally is no longer content merely to prescribe and operate: he needs to enter the community to advocate health policy (community health advocate), to disseminate disease-prevention knowledge to residents (health educator), to coordinate and allocate grassroots medical resources (service manager), to make wise decisions in clinical practice that balance individual and population (decision-maker), and ultimately to provide comprehensive, continuous health care for each person (care provider).
The significance of the Five-Star Doctor idea is that it gives the general-practice physician, from a global perspective, a role mission beyond the traditional "see the patient and write the prescription," making "person-centeredness" not a slogan but an operational, evaluable practice framework. When a physician is asked to play these five roles at once, his focus naturally expands from "this person's disease" to "the person himself"—his life, his family, his social environment, his health needs. This is precisely the concrete embodiment, at the level of the physician's role, of the shift from "the disease of a person" to "the person with a disease."
II. Three Levels of Prevention—the Core Path of the Five-Star Doctor's Practice
Ancient TCM attached great importance to "treating the not-yet-diseased," regarding it as the level of the "superior physician." The Lingshu says, "The superior physician treats the not-yet-diseased, not the already-diseased." The Suwen also says, "The sage does not treat the already-diseased but treats the not-yet-diseased; he does not manage the already-chaotic but manages the not-yet-chaotic. This is what is meant. To administer medicine after disease has formed, or to suppress rebellion after disorder has arisen, is like digging a well after one is thirsty, or casting weapons after the battle has begun—is it not too late!"
When one first studies medicine, these words may sound like grand, useless platitudes. But with more than twenty years of clinical work, if we are willing to settle and reflect, we feel these words deeply. Patients grow ever more numerous, the doctor-patient relationship grows ever more tense, the physician's personal safety is hard to guarantee, and the sense of achievement this profession brings grows ever smaller; many people develop burnout. Under such a model, not only do patients fall ill, but the treating physicians can hardly secure their own health and safety.
What was our original purpose in studying medicine? Was it so that one day we would deeply hate this profession? So that every day we go to work in fear and come off work exhausted? So that there are endless medical records to write, endless conversations to have, and endless informed-consent forms to sign? The informed-consent form is only a legal shell; it is effective only for patients willing to pursue legal process, and for patients who are not, it is just so much wastepaper.
Human beings invented medicine to promote human physical and mental health. Judged from this fundamental purpose, the health-care effect of the scalpel is inferior to that of preventive medicine.
Within the framework of modern preventive medicine, disease control is divided into three levels, forming a "three-tier protective net" covering the whole process of disease occurrence, development, and outcome. The general-practice doctor is precisely the net's core weaver and guardian at the grassroots. The five roles of the Five-Star Doctor have clear projections at each level of prevention.
(1) Primary Prevention: Preventing Disease Before It Arises—Building the "First Dam" of Health
Primary prevention, also called etiological prevention, is the most proactive, economical, and effective of the three levels. Its core idea is "prevent trouble before it arises"—before disease has sprouted, eliminating or reducing, at the source, the harm of pathogenic factors to the body.
For the general-practice doctor, primary prevention permeates every detail of daily service: conducting health education in the community to help residents build healthy lifestyles of reasonable diet, regular exercise, smoking cessation and moderate drinking, and psychological balance; arranging vaccination for age-appropriate groups to build immune barriers; paying attention to high-risk groups and providing early intervention and lifestyle guidance for those with chronic-disease family history, obesity, or pre-hypertension; and improving living and working environments to reduce exposure to harmful substances.
At this level, the general-practice doctor plays both the health educator and the community health advocate: he not only tells residents "what to do" but actively promotes community environments and policies that support health. The object of primary prevention is healthy people, which precisely embodies general practice's idea of "extending the object of study to healthy people" and the Five-Star Doctor's requirement to "leave the consulting room and enter the community."
(2) Secondary Prevention: Early Detection and Early Treatment—Catching the "First Threads" of Disease
Secondary prevention, also called pre-clinical prevention, centers on the "three early" principle of early detection, early diagnosis, and early treatment; for infectious diseases, there are also early reporting of outbreaks and early isolation of patients, following the "five early" principle.
Many chronic diseases and malignant tumors have almost no obvious symptoms early on; by the time the patient feels unwell and seeks care, the disease has often reached middle or late stage, greatly raising the difficulty and cost of treatment. Secondary prevention is about catching the early signals of disease within this "window period."
The general-practice doctor is the ideal executor of periodic health examinations and high-risk-group screening. Through regular physical exams, blood-pressure and blood-glucose monitoring, and cancer screening, the general-practice doctor can discover potential health problems before symptoms appear and intervene in time to block disease progression.
For example, a seemingly healthy middle-aged person found on a checkup to have blood glucose in the "prediabetic" range can, through dietary guidance, exercise prescription, and regular follow-up, quite possibly be helped to reverse the trend and avoid developing true diabetes.
At this level, the general-practice doctor plays the role of decision-maker: based on comprehensive assessment, he judges who needs screening, when, and how to intervene, putting limited medical resources where they are most needed. The object of secondary prevention is the group that "seems healthy but already hides risk"; this requires the general-practice doctor to have keen observation and comprehensive assessment ability, truly shifting the gaze from "disease that has occurred" to "disease that is forming."
(3) Tertiary Prevention: Preventing Disability After Disease—Guarding Dignity and Quality of Life
Tertiary prevention, also called clinical prevention, targets patients already diagnosed. Its goal is not "cure"—some diseases truly cannot be rooted out—but, through standardized treatment and rehabilitation management, to prevent deterioration, prevent complications and disability, restore the patient's function to the greatest extent, and improve quality of life.
Within general practice, tertiary prevention is more than prescribing and operating; it includes long-term chronic-disease management, individualized rehabilitation training, psychological counseling, and social support. After a stroke patient is discharged, the general-practice doctor keeps watch over his blood-pressure control and medication adherence, coordinates limb rehabilitation and speech training, attends to his psychological state, teaches the family caregiving skills, and helps him rejoin family and community life.
At this level, the general-practice doctor plays the dual role of care provider and service manager: he not only provides medical services but coordinates rehabilitation resources and social support networks, ensuring continuous, complete care. The object of tertiary prevention is "the person with a disease"—a whole person with emotions, a social role, and life needs. The general-practice doctor cares not only about "whether the disease is cured" but also about "whether this person is living well."
III. When Medicine Sees Only "Disease"—Why Doctor-Patient Trust Grows Ever More Distant
In recent years, the doctor-patient relationship has often been a focus of public concern. Incidents of violence against physicians are heartbreaking, and what is even more thought-provoking is this: why do doctors and patients, who should be "comrades in the same trench," so often stand on opposite sides?
The answer may lie in the divide between "the disease of a person" and "the person with a disease."
When medicine's gaze is fixed only on "the disease of a person," the consultation easily becomes a cold assembly line: register, queue, examine, prescribe, done. The patient enters the consulting room with anxiety and fear, only to face a "technical system" focused on lab slips and imaging reports. The physician has no time to listen to the patient's worries, and the patient does not feel respected or understood. Under this model, the doctor sees "disease," the patient feels "cold," and trust cannot be built.
The Five-Star Doctor idea precisely identifies the crux: when the physician is defined only as a "disease treater," neglecting the comprehensive roles of health education, community advocacy, and resource management, the doctor-patient relationship inevitably becomes utilitarian and short. The patient feels a "one-time transaction" rather than "ongoing companionship and care."
The root of many doctor-patient conflicts is not technical error but the absence of humanistic care. What patients need is not only a diagnosis but also someone willing to listen, to explain, and to accompany. When medicine degenerates into pure technical operation, and when the patient is reduced to a medical record, a bed number, a set of data, estrangement and distrust inevitably grow.
IV. From "the Disease of a Person" to "the Person with a Disease"—The Fundamental Path to Rebuilding Trust
The person-centeredness advocated by general practice, together with the Five-Star Doctor role framework, is precisely the key to resolving this predicament.
From "the disease of a person" to "the person with a disease" means that the physician no longer asks only "where do you feel unwell" but further cares about "what is your life like," "can your family support your recovery," and "where do your fears and anxieties come from." This shift in perspective returns medicine to the connection between people.
The five roles of the Five-Star Doctor provide concrete action guidance for this connection. In primary prevention, the general-practice doctor, as health educator and community advocate, enters the community and builds long-term health partnerships with residents—not "seen only when ill" but "seen also when well"; trust grows naturally in daily interaction. In secondary prevention, the physician, as decision-maker, through continuous health monitoring and follow-up, lets residents feel that "someone cares about my health," not that "someone steps in only after something goes wrong." In tertiary prevention, the physician, as care provider and service manager, through long-term companionship and comprehensive care, lets the patient feel he is not fighting alone but has a trustworthy team behind him.
This model of care, based on long-term relationships, comprehensive concern, and proactive service, fundamentally changes the doctor-patient interaction—from "one-time transaction" to "ongoing companionship," from "passive seeking of care" to "active cooperation," and from "mutual distrust" to "mutual entrustment."
V. From Idea to Practice: The General-Practice Doctor Is the Best Practitioner of Three-Level Prevention and the Five-Star Ideal
The three levels of prevention are interlocked and progressive, each indispensable. The five roles of the Five-Star Doctor are not isolated but mutually supporting. And the general-practice doctor, because of the breadth of the population served, the continuity of his service content, and the comprehensiveness of his service approach, is naturally the best executor of making three-level prevention land at the grassroots and taking root the Five-Star ideal.
From health promotion for healthy people in primary prevention, to early screening of high-risk groups in secondary prevention, to long-term management and rehabilitation support for patients in tertiary prevention—the general-practice doctor's work runs through the whole cycle from health to disease to recovery. Every role of the Five-Star Doctor is fully embodied in this full-cycle service.
This is the deeper meaning of the shift from "the disease of a person" to "the person with a disease": we no longer fixate on an organ, an indicator, or a diagnosis, but turn our gaze to a whole, warm person in a particular living environment. Using the idea of three-level prevention, we guard him before disease arises, discover him as disease sprouts, and accompany him after disease has taken hold. Holding ourselves to the Five-Star Doctor standard, we not only treat disease but also act as health educators, community advocates, and resource managers.
And when we truly see the "person," the gulf that seems so hard to cross between doctor and patient quietly melts away in this seeing and understanding.
The essence of medicine has never been merely to fight disease; it is to guard the person. General practice, with its person-centered idea, its three-level-prevention practice, and its Five-Star Doctor role framework, interprets this essence to the fullest.
These are my reflections from studying general practice and preventive medicine. I first became interested in medicine because my mother was ill in my childhood, and also because I greatly admired the "barefoot doctor" in our village—a loud-voiced, optimistic, cheerful man who was a close friend of my father's.
In fact, the "barefoot doctors" of 1970s–80s China played exactly the role of the general-practice doctor. They were well-liked in the village; they and their patients were both physician-patient and neighbors, and in large villages settled by a single surname, doctor and patient even shared blood ties. The doctor would not fleece the patient, and the patient would not resent the doctor; the doctor-patient relationship was harmonious.
That was the ideal professional model in my mind, but as society has changed, we can hardly return to that era. Yet the working model I keep thinking of is exactly that.
My present and future circumstances closely resemble this model. For a long time I have used my own self-media for medical popularization, building a readership of more than 100,000 people.
Among these readers, about five or six thousand have formed long-term relationships with me, and about one or two thousand even regard me as their family doctor. Whenever they have a problem, they first come to consult me, and we get along harmoniously. I dislike complicated human relationships and like simple, harmonious, lasting company, so this medical model suits my personality better.
I think what I most should do in future is put this Five-Star Doctor ideal into practice among this group, forming a harmonious whole with them and safeguarding their health. That would also fulfill my childhood dream of being a doctor.
Through studying general practice and preventive medicine, I have gained a clearer understanding of my future professional character; this may count as one of the greatest gains of my time at university.