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Clarifying the concepts, epistemology and lexicon of person-centeredness: an essential pre-requisite for the effective operationalization of PCH within modern healthcare systems

Andrew Miles, Jonathan Elliott Asbridge

Abstract


In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’

Keywords


Conceptual clarification, contextualisation, definitions on person-centered care, disease-centered medicine, empirical research base, evidence-based medicine, excellence in clinical practice, humanism, leadership, lexicon, methodology

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References


Miles, A. & Asbridge, J.E. (2014). Contextualizing science in the aftermath of the evidence-based medicine era: on the need for person-centered healthcare. European Journal for Person Centered Healthcare 1, 285-289

Charon, R. (2006). The self-telling body. Narrative Inquiry 19, 191-200.

Weatherall, D. (1996). Science and the Quiet Art: The Role of Medical Research in Health Care. New York: W.W. Norton.

Miles, A. (2013). Person-centered medicine - at the intersection of science, ethics and humanism. International Journal of Person Centered Medicine 2, 329-333.

Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern medical practice. International Journal of Person Centered Medicine 1, 207-222.

Loughlin, M. (2014). What person-centered medicine is and isn’t: temptations for the ‘soul’ of PCM. European Journal for Person Centered Healthcare 2, 16-21.

Fuller, J. & Upshur, J.E. (2014). Logos, ethos and pathos in balance. Commentary on Miles and Mezzich. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. [International Journal of Person Centered Medicine 1 (2) 207-222.] European Journal for Person Centered Healthcare 2, 22-29.

Elwyn, G. (2014). Shared decision-making: merging evidence into patient-centered care. European Journal for Person Centered Healthcare 2, 30-31.

Kirkengen, A. L., Mjolstad, B. P, Getz, L., Ulvestad, E. & Hetlevik, I. (2014). Can person-free medical knowledge inform person-centered medical practice? Comment on the discussion paper “The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice” by Miles and Mezzich. (2011). [IJPCM 1 (2) 207-222.] European Journal for Person Centered Healthcare 2, 32-36.

Little, M. (2014). Theorising personhood: for better or for worse. European Journal for Person Centered Healthcare 2, 37-45.

Wyer, P.C. & da Silva, S.A. (2014). Through a Glass, Darkly: The challenge of integration of the science and the art of medicine. Commentary on: Miles, A. & Mezzich, J.E. The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. [International Journal of Person Centered Medicine (2011) 1 (2) 207-222.] European Journal for Person Centered Healthcare 2, 46-53.

Rothenberger, L.G. (2014). Response to the Discussion Paper: Miles, A. & Mezzich, J.E. The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. [International Journal of Person Centered Medicine (2011) 1 (2) 207-222.] European Journal for Person Centered Healthcare 2, 54-56.

Little, M. (2014). The precarious future of the discourse of person-centered medicine. European Journal for Person Centered Healthcare 2, 57-63.

Nunn, R. (2014). Adaptive many model medicine trumps monocultural models: comment on the Miles and Mezzich emergent model of modern clinical practice. European Journal for Person Centered Healthcare 2, 64-66.

Charles, C. & Gafni, A. (2014). Commentary on Discussion Paper by Miles, A. and Mezzich. J.E. (2011). Person-centered medicine as an emergent model of clinical practice: the devil is in the details. European Journal for Person Centered Healthcare 2, 67-70.

Tonelli, M.R. (2014). Clinical decision-making for a person-centered medicine: the necessity of casuistic reasoning. A response to: Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. [International Journal of Person Centered Medicine 1 (2) 207-222.] European Journal for Person Centered Healthcare 2, 71-75.

Post, P.N. & Guyatt, G.H. (2014). Evidence-based medicine offers an optimal starting point for person-centered medicine. European Journal for Person Centered Healthcare 2, 76-78.

Hutchinson, T.A., Dobkin, P.L., Jordan, S., Liben, S. & Smilovitch, M. (2014). Response to discussion paper by Miles and Mezzich. European Journal for Person Centered Healthcare 2, 79-80.

Kerry, R., Anjum, R.L. & Mumford, S.D. (2014). Response to Miles and Mezzich “Causation as a way forward in person-centered medicine”. European Journal for Person Centered Healthcare 2, 81-82.

Turner, A., Blakey, J.D. & Kerry, R. (2014). Response to Miles and Mezzich “Medicine in crisis and a crisis in semantics”. European Journal for Person Centered Healthcare 2, 83-84.

Sturmberg, J. P. (2014). Person-centered medicine from a complex adaptive systems perspective. European Journal for Person Centered Healthcare 2, 85-97.

Griggs, J.O., Barron, L.A. & Marcum, J.A. (2014). Operationalizing Miles and Mezzich’s person-centered medicine. European Journal for Person Centered Healthcare 2, 98-105.

Goldenberg, M.J. (2014). Is ‘scientifically informed, yet humanistic medicine’ the solution to the crisis of modern medicine? A friendly corrective to the emergent model of person-centered medicine. European Journal for Person Centered Healthcare 2, 106-113.

Miles, A. & Asbridge, J.E. (2014). Person-centered Healthcare: Theory and Practice. European Journal for Person Centered Healthcare. In Press.

Miles, A., Bentley, D.P., Polychronis, A. & Grey J.E. (1997). Evidence-based medicine: why all the fuss? This is why. Journal of Evaluation in Clinical Practice 3: 83-86.

Miles, A. (1997). Evidence-based medicine. European Journal of Emergency Medicine 4, 1-9.

Charlton, B.G. & Miles, A. (1998). The rise and fall of EBM. Quarterly Journal of Medicine 91, 371-374.

Miles, A., Bentley, D.P., Polychronis, A., Grey, J.E. & Price, N. (1999). Advancing the evidence-based healthcare debate. Journal of Evaluation in Clinical Practice 5, 97-101.

Miles, A., Charlton, B., Bentley, D.P., Polychronis, A., Grey, J.E. & Price N. (2000). New perspectives in the evidence-based healthcare debate. Journal of Evaluation in Clinical Practice 6, 77-84.

Miles, A., Bentley, D.P., Polychronis, A., Grey, J.E. & Melchiorri, C. (2001). Recent developments in the evidence-based healthcare debate. Journal of Evaluation in Clinical Practice 7, 85-89.

Miles, A., Grey, J.E., Polychronis, A. & Melchiorri, C. (2002). Critical advances in the evaluation and development of clinical care. Journal of Evaluation in Clinical Practice 8, 87-102.

Miles, A., Grey, J.E., Polychronis, A., Price, N. & Melchiorri, C. (2003). Current thinking in the evidence-based healthcare debate. Journal of Evaluation in Clinical Practice, 9, 95-109.

Miles, A., Grey, J.E., Polychronis, A., Price, N. & Melchiorri, C. (2004). Developments in the evidence-based healthcare debate – 2004. Journal of Evaluation in Clinical Practice 10, 129-142.

Miles, A., Polychronis, A. & Grey, J.E. (2006). The evidence-based health care debate - 2006. Where are we now? Journal of Evaluation in Clinical Practice 12, 239-247.

Miles, A. & Loughlin, M. (2006). The evidence-based health care debate - 2006. The progress and price of EBM. Journal of Evaluation in Clinical Practice 12, 385-398.

Miles, A., Loughlin, M. & Polychronis, A. (2007). Medicine and evidence: knowledge and action in clinical practice. Journal of Evaluation in Clinical Practice 13, 481-503.

Miles, A. (2009). Evidence-based medicine: requiescat in pace? Journal of Evaluation in Clinical Practice 15, 924-929.

Miles, A. (2009). On a Medicine of the Whole Person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. Journal of Evaluation in Clinical Practice 15, 941-949.

Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualised care. Journal of Evaluation in Clinical Practice 17, 531-536.

Miles, A. & Asbridge, J.E. (2013). The European Society for Person Centered Healthcare. European Journal for Person Centered Healthcare 1 (1) 4-40.

Miles, A. (2007). Science: a limited source of knowledge and authority in the care of patients. Journal of Evaluation in Clinical Practice 13, 545-563.

Salzburg Global Seminar. (2010). Informing and involving patients in decisions about their medical care, 12-17 December 2010. www.salzburgglobal.org/go/477.

Miles, A. (2012). Moving from a reductive anatomico-pathological medicine to an authentically anthropocentric model of healthcare: current transitions in epidemiology and epistemology and the ongoing development of person-centered clinical practice. International Journal of Person Centered Medicine 2, 615-621.




DOI: http://dx.doi.org/10.5750/ejpch.v2i1.857

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