The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Human Understanding is Expected of the Physician: Proposing a Model of Disease Development

의사에게 요구되는 인간이해를 통합한 질병발생모델의 제안

  • Sang-Heum Park (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Samel Park (Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Jin Young Kim (Division of Respiratory Allergy and Critical Care Medicine, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Hyeon Ah Lee (Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Sang Mi Lee (Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Tae Hoon Lee (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Sang Byung Bae (Division of Oncology and Hematology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Sung Hae Chang (Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Si Hyong Jang (Department of Pathology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Sung Wan Chun (Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicien) ;
  • Jong Ho Moon (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
  • 박상흠 (순천향대학교 의과대학 순천향대학교 천안병원 소화기내과) ;
  • 박삼엘 (순천향대학교 의과대학 순천향대학교 천안병원 신장내과) ;
  • 김진영 (순천향대학교 의과대학 순천향대학교 천안병원 호흡기알레르기내과) ;
  • 이현아 (순천향대학교 의과대학 순천향대학교 천안병원 정신건강의학과) ;
  • 이상미 (순천향대학교 의과대학 순천향대학교 천안병원 핵의학과) ;
  • 이태훈 (순천향대학교 의과대학 순천향대학교 천안병원 소화기내과) ;
  • 배상병 (순천향대학교 의과대학 순천향대학교 천안병원 종양혈액내과) ;
  • 장성혜 (순천향대학교 의과대학 순천향대학교 천안병원 관절류마티스내과) ;
  • 장시형 (순천향대학교 의과대학 순천향대학교 천안병원 병리과) ;
  • 전성완 (순천향대학교 의과대학 순천향대학교 천안병원 내분비대사내과) ;
  • 문종호 (순천향대학교 의과대학 순천향대학교 부천병원 소화기내과)
  • Received : 2023.10.05
  • Accepted : 2023.11.22
  • Published : 2024.04.01
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Abstract

In Harrison's Principles of Internal Medicine, human understanding is emphasized as one of three necessary characteristics that a physician must have. Inflammation, which is caused by inflammatory inducers (inf-ids), is a fundamental feature of disease at the cellular and molecular levels. Inflammation protects the body, but excessive or prolonged inflammation can be damaging and can cause disease. Humans are repeatedly exposed to external and internal environmental factors that generate inf-ids throughout their lives. External environmental factors include microbial and non-microbial inf-ids, as well as stressors that inevitably arise during social interactions. Internal environmental factors include the adaptive physiological response that is present from birth. Inf-ids may also be produced by the four-step habit loop, which consists of a cue (e.g., stressor), emotions, routine act (adaptive response), and a reward. Immune cells in the circulatory system and in tissues may have positive and negative effects in inflammatory responses. However, low-grade inflammation may be difficult to detect. We propose a model of disease development that integrates external and internal environmental factors from the perspective of human understanding.

Keywords

Acknowledgement

The authors would like to thank Shi Nae Yu, M.D., Division of Infectious Diseases, Department of Internal Medicine, Sae Hwan Lee, M.D., Division of Gastroenterology, Department of Internal Medicine, Young Sin Cho, M.D., Division of Gastroenterology, Department of Internal Medicine, and Jin Myoung Seok, M.D., Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea, for recommending references.

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