Person-Centered Medicine: An Existential Outline beyond the Biopsychosocial Model

Abstract

Starting from the idea that “medical problems” are always “problems of living” that reflect the existence of a “vital dimension” that is different from the biological, psychological and sociocultural dimensions, this article describes central features of this dimension. From this viewpoint, its inescapable importance in the clinical act is highlighted, an importance that shapes the tasks that are inherent to it – diagnosis and decision making – but also the very process of the doctor-patient relationship. It is argued that “the subjective truth” implicit in the “vital dimension” (in the “existential self”) can only be approached through reflection and interpretation in the context of a dialogue between the professional and the patient/family with the objective of deciding on the action(s) that can better lead to reaching some concrete wishes or desires (values), that in turn require the participants to take on obligations and responsibilities. This relational perspective defines the “person centered” clinical approach as a practice based on dialogue, importantly involving deliberation and collaboration (“collaborative deliberation”). In this dialogue, the emotions, integral elements of the life dimension of its protagonists, play a decisive role both in attaining clinical effectiveness and in building and maintaining the relational process (encouraging or reducing trust) that is indispensable in a clinical activity that is an eminently moral act. Finally, the main challenges that doctors face when implementing this clinical focus and the educational challenges it entails are outlined.