The patient, the illness, the doctor, the decision: negotiating a ‘new way’ through person-centered medicine

Abstract

Medicine has a unique understanding of the physical, psychological, spiritual and social dimensions of what it is to be human and nowhere within modern medicine today is the need for greater cognition more acutely necessary than in the understanding of the patient as a person. Concerns with medical humanism, which are increasingly apparent within global healthcare services and policymaking, far from detracting from continuing progress in medicine’s scientific character, enable a far more effective practice of medicine than each can possibly do in isolation from the other. The argumentation for augmentation of this nature enables a re-assertion and a re-establishment of some of the core tenets of medical philosophy and theory that have become progressively lost in over a century of positivistic empiricism. It is argued that unlike the 20th Century which was concerned with rapid scientific progress, the 21st Century should be characterised by a concern with both science and the whole person. In order to achieve such a vision in practice, a continuing articulation of medicine’s scientific nature via the evidence-based medicine (EBM) movement and a continuing articulation of patients’ rights through the person-centered care (PCC) movement, should no longer compete for audition in separate arenas or when together in the manner of a dialogue of the deaf. Rather, the more philosophically tenable components of each model should embark upon a process of coalescence, enabling shared clinical decision-making to be able to take account of a range of human concerns as well as being actively informed by accepted and reliable science. Although such a process will not of itself correct the current crisis in medicine – a crisis of knowledge, care, compassion and costs – it will play a highly valuable part in returning to clinical practice radical concerns for the proper care of the patient and the overt soul of the clinic. Without such progress, healthcare standards will continue to slide, inexorably it seems, to the lowest common denominator that is legally tolerable. The humanistic dimension of medicine is not an optional extra. On the contrary, its application is what separates the physician from the veterinary surgeon. The trajectory we describe can be summarily interrupted in accordance with the new World Health Organisation imperatives, by the development and implementation of person-centered medicine, an emergent model of modern clinical practice.