The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice

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Published: Jun 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i2.61

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Andrew Miles
WHO Centre for Public Health Education and Training, Imperial College, London
Juan Mezzich
Mount Sinai School of Medicine, New York University, United States of America.

Abstract

Despite exponential increases in biomedical and technological advance over the 100 years that have radically transformed the scope, possibility and power of clinical practice, there is a growing and pervasive sense of unease within international medicine that all is not entirely well, leading to claims that medicine has entered a time of significant crisis - a crisis of knowledge, care, compassion and costs. As medicine has become more powerfully scientific, it has also become increasingly depersonalised, so that in some areas of clinical practice an over-reliance on science in the care of patients has led to the substitution of scientific medicine with scientistic medicine and an accompanying collapse of humanistic values in the profession of medicine.  Since medicine has the unalterable imperative to care, comfort and console as well as to ameliorate, attenuate and cure, the perpetuation of a modern myth in medicine - that now that we can cure we have no more responsibility to care - risks the creation of an ethical and moral chaos within clinical practice and the generation of negative outcomes for both patients and clinicians alike.  With reference to these observations and concerns, we briefly review signal occurrences in the development of the so-called ‘patient as a person’ movement. We then comment on the emergence and progress of the separate evidence-based medicine (EBM) and patient-centered care (PCC) movements, noting how these initiatives have developed in parallel, but how rarely they have entered into exchange and dialogue.  Contending that both such movements have greatly enriched the understanding of the profession of medicine, we nevertheless argue that each model remains of itself essentially incomplete as a coherent account of the unique undertaking that is clinical medicine and argue for the need for a rational form of integration to take place between them.  Such a coalescence would allow the persons of the patient and clinician(s) to engage in a mutual and dialogical process of shared decision-making within a relationship of equality, responsibility and trust while ensuring that clinical practice remained actively informed by accumulating biomedical science.  We recommend that such a development should take place as part of a wider shift within health services, assisting a move away from impersonal, fragmented and decontextualised systems of healthcare towards personalised, integrated and contextualised models of clinical practice, so that affordable biomedical and technological advance can be delivered to patients within a humanistic framework of care which recognises the importance of applying science in a manner which respects the patient as a person and takes full account of his values, preferences, stories, cultural context, fears, worries and hopes and which thus recognises and responds to his emotional, spiritual and social necessities in addition to his physical needs. This, we contend, is person-centered medicine, an emergent model of modern clinical practice.

Article Details

Issue
Vol. 1 No. 2 (2011): June
Section
Regular Articles
Author Biographies

Andrew Miles, WHO Centre for Public Health Education and Training, Imperial College, London

Editor-in-Chief, International Journal of Person Centered Medicine & Professor of Clinical Epidemiology and Social Medicine, Medical School, University of Buckingham, UK Professor Miles, MSc, MPhil, PhD is a senior public health scientist. He previously held professorships and senior fellowships at King’s College University of London, Queen Mary College University of London, the University of East London, the University of Westminster, the University of Surrey and the University of Wales.He is Editor-in-Chief and Chairman of the International Advisory Board of the Journal of Evaluation in Clinical Practice, a leading and highly ranked international periodical for public health policy and health services research published by Wiley Blackwell Ltd with high impact factor and citation rate and extensive world circulation.Professor Miles is National Director and Editor-in-Chief of the UK Key Advances in Clinical Practice Series, a major collaboration between medical Royal Colleges and UK specialist clinical societies in a multi-disciplinary contribution to the evaluation and development of clinical practice in the UK, resulting in the organisation of some 22 annually recurring national conferences and some 22 annually updated, extensively referenced clinical texts which serve to document current scientific evidence and expert clinical opinion for the investigation and management of common diseases, the results of which are widely disseminated across the medical community of the UK. The Series entered its 13th successful annual cycle in January 2010.He is Director and Editor-in-Chief of the UK Masterclasses in Effective Clinical Practice Series in collaboration with the medical Royal Colleges and specialist clinical societies which examines how ‘general research evidence’ derived from the clinical literature is successfully applied to the care of difficult individual patients as part of the development of UK knowledge-based clinical practice.Professor Miles is an accomplished teacher at both undergraduate and postgraduate levels in public health and social medicine, and experienced in Master’s level course development and validation, and in university committee work and higher degree supervision at Master’s degree and PhD levels.He has published extensively in his field: over 50 edited textbooks in public health sciences and health services research, together with substantial numbers of original articles in leading peer-reviewed international clinical journals. He has contributed extensively to the international evidence-based medicine debate and to the development of thinking on the nature of knowledge for clinical practice. He has provided the intellectual leadership and organisational skills for 89 national clinical conferences and 26 national clinical masterclasses from 1998 to date. He regularly lectures at national and international conferences, and has made a substantial contribution to British medical education and clinical scholarship.

Juan Mezzich, Mount Sinai School of Medicine, New York University, United States of America.

Deputy Editor-in-Chief, International Journal of Person Centered Medicine, President, International College of Person-Centered Medicine, Former President World Psychiatric Association and Professor of Psychiatry, Mount Sinai School of Medicine, New York University, United States of America.

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