What is Person Centered Medicine: Conceptual Review with Focus on George Engel’s Perspectives

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Published: Jul 13, 2016
DOI: https://doi.org/10.5750/ijpcm.v6i2.575
Keywords:
Person-centered medicine patient-centered medicine biopsychosocial model existential dimension life dimension communication interpretation hermeneutics

Main Article Content

Roger Ruiz-Moral
Professor of Medicine and Director, Clinical Communication, Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain

Abstract

Background: “Person centered medicine” has recently emerged as a new alternative to “patient centered medicine” with the aim of representing a different focus for clinical practice. However, it is still necessary to clarify its conceptual bases and its identifying features. Objectives: To review the conceptual bases of Person Centered Medicine and highlight its main features. Methods: A non systematic review of the literature on the person and patient centered medicine field and particularly the works that George Engel published in 1977 and 1980 in which this author proposed the biopsychosocial (BPS) model as an alternative to the biomedical one. Results: The analysis led to identify one element, a “life dimension” that differs from the biopsychosociocultural determinants that are typical of the BPS and that until now has not been well understood.  The “life dimension” takes shape in the interpretation that the person makes of a series of concrete experiences and their consequences, “problems of living”, that are liable to be considered “medical problems”. This is what leads the person to adopt the condition of being a patient (patienthood). Consequently, any medical problem is above all a problem of living or, in other words, a manifestation of a “life or existential dimension” that is inherent to the person (personhood). This perspective requires the physician to consider this dimension along with the model's other components in any clinical interaction, and it is the basis for the use of a hermeneutic or interpretative methodology that has communication and dialogue as its main tools. Conclusions: The term “person centered medicine” reflects the clinical focus that takes into account the “life dimension” of the person. Further research is needed to elucidate the meaning of this dimension as a basis to clarify both the concept of this clinical approach and its main practical elements.

Article Details

Issue
Vol. 6 No. 2 (2016)
Section
Regular Articles

References

. Peabody, F. W. The care of the patient. Journal of the American Medical Association 1927; 88: 877 – 882.

. Paul Tournier. The healing of Person. Harper & Row 1965

. Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-136

. Engel G. The clinical appplication of the biopsychosocial model. Am J Psychiatry. 1980;137:535-544

. Lain Entralgo P. Doctor and Patient. New York: McGraw Hill Book Company, 1969

. Balint E. The possibilities of patient-centered medicine. J Roy Coll Gen Pract 1969;17:269-76

. Laine C, Davidoff F. Patient-Centered MedicineA Professional Evolution. JAMA. 1996;275(2):152-156

. Stewart M. Towards a global definition of patient centred care. BMJ 2001;322:444-5

. Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine: transforming the clinical method. Second edition. Radcliffe Medical Press Ltd. 2003 4 pts, 21 chapters.

. Epstein RM, Street RL. The Values and Value of Patient-Centered Care. Ann Fam Med. 2011 Mar; 9(2): 100–103.

. Berwick DM. What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist. Health Aff 2009;28:w555-w565.

. Bardes CL. Defining “Patient-Centered Medicine” N Engl J Med 2012;366:782-3.

. McWhinney I. A Textbook of Family Medicine. Oxford: Oxford University Press, 1989.

. Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Aff (Millwood) 2010 Aug;29(8):1489–95

. W Levinson, CS Lesser, RM Epstein Developing physician communication skills for patient-centered care. Health Aff (Millwood) 2010.

. Cosgrove T. The Cleveland Clinic Way: Lessons in Excellence from One of the World's Leading Health Care Organizations. New York: McGraw Hill Education, 2014.

. Winefield H, Murrell T, Clifford J, Farmer E. The search for reliable and valid measures of patient-centredness. Psychology and Health 1996;11:811-824.

. Mead N, Bower P. Measuring patient-centredness: a comparison of three observation-based instruments- Patient Education and Counseling, 2000; 39: 71-80..

. Mead N, Bower P. Hann M. The impact of general practitioners’ patient-centeredness on patient post consultation satisfaction and enablement. Soc Sci Med 2002;55:283-9.

. Howie J G, Heaney D, Maxwell, M. Quality, core values and the general practice consultation: Issues of definition, measurement and delivery. Family Practice 2004;21,458–468.

. Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, Duberstein PR. Measuring patient-centered communication in patient–physician consultations: Theoretical and practical issues. Soc Scien Med 2005;61:1516–1528.

. Hudon C, Fortin M Jeannie L. Haggerty JL, Lambert, M Poitras ME. Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine. Ann Fam Med 2011;9:155-164

. Starfield B. Is Patient-Centered Care the Same As Person-Focused Care? The Permanente Journal 2011;15:63-69

. World Health Organization on behalf of the European Observatory on Health Systems and Policies. Nolte E, McKee M (eds). Caring for people with chronic conditions. A health system perspective. New York: McGraw Hill Education. Open University Press, 2008

. Nasmith L, Ballem P, Baxter R, et al. Transforming care for Canadians with chronic health conditions: put people first, expect the best, manage for results [monograph on the Internet]. Ottawa, Ontario, Canada: Canadian Academy of Health Sciences; 2010 [cited 2011 Jan 24]. Available from: www.cahs-acss.ca/e/pdfs/cdm%20final%20English.pdf.

. Starfield B. Primary care and equity in health: the importance to effectiveness and equity of responsiveness to peoples’ needs. Humanity and Society 2009;33:56–73

. Collins FS, Varmus H. A New Initiative on Precision Medicine. N Engl J Med 2015;372:973-5

. Zieglestein RC. Personomics. JAMA 2015; 175(6): 888-889.

. Miles A, Mezzich JE. The care of the patient and the soul of the clinic: person centered medicine as an emergent model of modern clinical practice. The International Journal of Person Centered Medicine 2011;1: 207-222

. Guyatt G, Montori V, Devereaux PJ, Schünemann H, Bhandari M. Patients at the center: in our practice, and in our use of language. ACP J Club. 2004;140(1):A11–A12

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

. Charles C, Gafni A. 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 2014; 2 :67-70

. Cassell, E. J. (2010). The person in medicine. International Journal of Integrated Care, 10 (Supplement) 50 –52

. Mezzich, J. E., Snaedal, J., van Weel, C. & Heath, I. (2010). From disease to patient to person: towards a person centered medicine. Mount Sinai Journal of Medicine, 77, 304 –306.

. Little M. The precarious future of the discourse of person-centerd medicine. European Journal for Person centered helathcare 2014;2:57-63

. Turner JH: Analytical Theorizing. In Social Theory Today. Edited by Giddens A, Turner J. Cambridge: Polity Press; 1987, pp.156-194.

. Pellegrino ED. For the patient’s good: the restoration of beneficence in health care. Oxford: Oxford University Press, 1988.

. Mckeown T, Lowe CR. Introduction to social medicine. London: Blackwell Science Ltd; 2nd edition, 1977.

. Starfield B. Primary Care: Balancing Health Needs, Services and Technology (Religion in America). Oxford (UK): Oxford University Press, 1998

. Gervás J. La expropiación de la salud. Madrid: Los libros del lince, 2015.

. Illich I. Medical Nemesis. The expropiation of health. New York: Pantheon books, 1976.

. Gervás J, Perez Fernández M. Sano y salvo (y libre de intervenciones médicas innecesarias). Madrid: Los libros del lince, 2015

. Visser MR, Smets EMA, Oort FJ, de Haes H. Stress, satisfaction and burnout among Dutch medical specialists. CMAJ February 4, 2003 vol. 168 no. 3, 271-5

. Sobrequés J, Cebriá J, Segura J, Rodríguez C, García M, Juncosa S. Job satisfaction and burnout in general practitioners. Atencion Primaria 2003;31:227

. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population Arch Intern Med. 2012;172(18):1377-1385

. Cooke M, Irby DM, Sullivan W, Ludmerer KM. American Medical Education 100 Years after the Flexner Report. N Engl J Med 2006; 355:1339-1344

. Monroe A, Quinn E, Samuelson W, Dunleavy DM, Dowd KW. An overview of the medical school admission process and use of applicant data in decision making: what has changed since the 1980s? Acad Med. 2013 May;88(5):672-81

. Branch W T. The Road to Professionalism: Reflective Practice and Reflective Learning, Patient Educ Couns 2010;80: 327-332

. van Weel-Baumgarten E, Bolhuis S, Rosenbaum M, Silverman J. Bridging the gap: How is integrating communication skills with medical content throughout the curriculum valued by students? Pat Edu Couns 2013;90:177-83

. Swick HM, Szenas P, Danoff D, Whitcomb ME. Teaching Professionalism in Undergraduate Medical Education JAMA. 1999;282(9):830-832

. Ferreira Padilla G, Ferrández Antón T, Baleriola Jílvez J, Almeida Cabrera R. Competencia en comunicación en el currículo del estudiante de medicina de España (1990-2014): de la Atención Primaria al Plan Bolonia. Un estudio descriptivo Aten Primaria. Communication skills in the curriculum of medical students from Spain (1990-2014): from Primary Health Care to Bologna Plan. A descriptive study. 2014

. Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2:576-82

. Fuller J, Upshur REG. Logos, ethos and pathos in balance - the care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. European Journal for Person Centered Healthcare 2013; 2: 22-29

. Borrell Carrio F. El modelo biopsicosocial en evolución. Med Clin (Barc) 2002;119:175-9

. Leder D. Clinical interpretation: the hermeneutics of medicine. Theoretical Medicine and Bioethics 1990;11, 9-24.

. Upshur R E. Priors and prejudice. Theoretical Medicine and Bioethics 1999;20: 319-327

. Bruner J. Actos de significado. Más allá de la revolución cognitiva. Madrid: Alianza 1991 (Acts of meaning. Boston: Harvard University Press, 1990)

. Kleinman AM. The Illness Narratives: Suffering, Healing, and the Human Condition. New York, NY: Basic Books, 1988.

. Bartz R. Beyond the biopsychosocial model. New approaches to doctor-patient interactions. J Fam Pract. 1999;48:601-607

. Helman CG. Culture, Health and Illness. London: Butterworth-Heinemann, 1993

. Rudebeck C. General practice and the dialo