What Person-Centred Medicine is and isn't: temptations for the ‘soul’ of PCM
Abstract
In their important discussion paper presenting person-centred medicine (PCM) as ‘an emergent model of modern clinical practice’ [1], Miles and Mezzich note a rather obvious comparison between the rhetoric of their own favoured ‘model’ and the rhetoric of the evidence-based medicine (EBM) movement. For all their differences, PCM and EBM have something in common. While we may disagree about what evidence is or indeed just not be sure what it is, we are generally agreed that we are in favour of it. A movement that is all about promoting the use of evidence in medicine sounds about as uncontroversial as it gets. I might be oblivious to scientific debates about the nature of evidence and have no idea how to define the term, but I know that I want anyone treating me to use evidence, all the same. I may wonder what else medical decisions should be based on, if not evidence? [2]. Similarly, it would make very little sense to be ‘against’ persons. I may have never given a moment’s thought to philosophical disputes about the nature of persons, but I know that however one defines persons, I am one of them and in reply to the question: ‘Should medicine care for persons or not?’ few would answer in the negative. Again, I might wonder: if medicine is not about caring for ‘the person’, then what is it about?
Full Text:
PDFReferences
Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person-centred medicine as an emergent model of modern clinical practice. International Journal of Person Centred Medicine 1 (2) 217-222.
Worrall, J. (2010). Evidence: philosophy of science meets medicine. Journal of Evaluation in Clinical Practice 16 (2) 356-362.
Loughlin, M. (2010). Spin-doctors. The Philosopher’s Magazine 51 (4) 68-73.
Charlton, B.G. (1996). The limits of evidence-based medicine. Hospital Update July, 268–269.
Djulbegovic, B., Guyatt, G.H. & Ashcroft, R.E. (2009). Epistemologic inquiries in evidence-based medicine. Cancer Control 16 (2) 158-168.
Goodman, K. (2003). Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science. Cambridge: Cambridge University Press.
Dans, A., Dans, L. & Silverstre, M. (2008). Painless Evidence-based Medicine. Chichester:Wiley.
Jenicek, M. (2006). Evidence-based medicine: fifteen years later. Golem the good, the bad and the ugly in need of a review? Medical Science Monitor 12, 241-251.
Loughlin, M. (2009). The search for substance: a quest for the identity-conditions of evidence-based medicine and some comments on Djulbegovic et al. Journal of Evaluation in Clinical Practice 15 (6) 910-914.
Miles, A., Loughlin, M. & Polychronis, A. (2008). Editorial Introduction and Commentary: ‘Evidence-based health care, clinical knowledge and the rise of personalised medicine’. Journal of Evaluation in Clinical Practice 14 (5) 621-649.
Loughlin, M. (2009). The basis of medical knowledge: judgement, objectivity and the history of ideas. Journal of Evaluation in Clinical Practice 15 (6) 935-940.
Evidence-Based Medicine Working Group. (1992). Evidence-based Medicine: a new approach to teaching the practice of medicine. Journal of the American Medical Association 268 (17) 2420-2425.
Davidoff ,F., Haynes, B., Sackett, D. & Smith, R. (1995). Evidence-based medicine. British Medical Journal 310, 1085-1086.
Kuhn, T.S. (1970). The Structure of Scientific Revolutions, 2nd Edition. Chicago: University of Chicago Press.
Sackett, D.L., Rosenberg, W.M.C., Muir Gray, J.A., Haynes, R.B. & Richardson, W.S. (1996). Evidence-based medicine: what it is and what it isn’t. British Medical Journal 312, 71-72.
Goldacre, B. (2006). Objectionable ‘objectives’. The Guardian August 19.
Loughlin, M. (2007). Style, Substance, Newspeak ‘and all that’: a commentary on Murray et al. (2007) and an open challenge to Goldacre and other ‘offended’ apologists for EBM. Journal of Evaluation in Clinical Practice 13 (4) 517-521.
Tonelli, M. (2006). Integrating evidence into clinical practice: an alternative to evidence-based approaches Journal of Evaluation in Clinical Practice 12 (3) 248-256.
Loughlin, M. (2006). The future for medical epistemology? Commentary on Tonelli’s ‘Integrating evidence into clinical practice: an alternative to evidence-based approaches’. Journal of Evaluation in Clinical Practice 12 (3) 289-291.
Loughlin, M. (2002). On the buzzword approach to policy formation, Journal of Evaluation in Clinical Practice 8 (2) 229-242.
Loughlin, M. (2004). Quality, Control and Complicity, International Journal of the Humanities 2, 717-724.
Loughlin, M. (2002). Ethics, Management and Mythology. Oxford: Radcliffe Medical Press.
Loughlin, M. (2002). Arguments at cross purposes: moral epistemology and medical ethics. Journal of Medical Ethics 28 (1) 28-32.
Loughlin, M. (2003). Critical thinking versus moral expertise: a commentary on Kottow’s ‘rationale for value-laden medicine’. Journal of Evaluation in Clinical Practice 9 (1) 92-94.
Halligan, A. & Donaldson, L. (2001). Implementing clinical governance: turning vision into reality. British Medical Journal 322, 1413-1417.
Halligan, A., Nicholls, S. & O’Neill, S. (2001). Clinical Governance: developing organisational capability. In: Clinical Governance and the NHS Reforms, pp. 129-1540. Miles, A., Hill, A. & Hurwitz, B. (eds.). London: Aesculapius Medical Press.
Peabody, F.W. (1928). The soul of the clinic. Journal of the American Medical Association 90, 1193-1197.
Sorabji, R. (1983). Time, Creation and the Continuum. London: Duckworth.
Miles, A. & Mezzich, J.E. (2011). Person-centred medicine: advancing methods, promoting implementation. International Journal of Person Centred Medicine 1 (3) 423-428.
Cox, J. (2010). Medicine of the Person and Personalised Care. Journal of Evaluation in Clinical Practice 16 (2) 315-317.
Gelhaus, P. (2011). I, Medical Robot: On the differences between a virtuous doctor and a good robot. International Journal of Person Centred Medicine 1 (2) 301-306.
Walsh,B. & Gillett, G. (2011). Is evidence-based medicine positivist? International Journal of Person Centred Medicine 1 (2) 323-329.
Little, M., Gordon, G., Markham, P., Lipwort, W. & Kerridge, I. (2011). Making decisions in mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners. International Journal of Person Centred Medicine 1 (2) 376-384.
Henry, S. (2010). Polanyi’s tacit knowledge and the relevance of epistemology to clinical medicine. Journal of Evaluation in Clinical Practice 16 (2) 292-297.
Macnaughton, J. (2011). Medical humanities’ challenge to medicine. Journal of Evaluation in Clinical Practice 17 (5) 927-932.
Ayer, A.J. (1987). Language, Truth and Logic. Harmondsworth, Middlesex: Penguin Books Ltd.
Gelhaus, P. (2011). Robot Decisions: the importance of virtuous judgement in clinical decision-making. Journal of Evaluation in Clinical Practice 17 (5) 833-837.
Marcum, J. (2011). The role of prudent love in the practice of clinical medicine. Journal of Evaluation in Clinical Practice 17 (5) 877-882.
Loughlin, M. (2008). Reason, reality and objectivity: shared dogmas in the way both scientistic and postmodern commentators frame the EBM debate. Journal of Evaluation in Clinical Practice 14 (5) 665-671.
Loughlin, M., Bluhm, R., Buetow, S., Goldenberg, M., Upshur, R., Borgerson, K. & Entwistle, V. (2011). Virtue, Progress and Practice. Journal of Evaluation in Clinical Practice 17 (5) 839-846.
Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualized care. Journal of Evaluation in Clinical Practice 17 (4) 531-536.
Howick, J. (2011). The Philosophy of Evidence-Based Medicine. Chichester: Wiley-Blackwell.
Tonelli, M. (2011). The philosophy of evidence-based medicine by Jeremy Howick. Journal of Evaluation in Clinical Practice 17 (5) 1013–1017.
Berwick, D.M. (2009). What ‘patient centred’ should mean: confessions of an extremist. Health Affairs 28, 555-556.
Berwick, D.M. (1993). Continuous Improvement as an Ideal in Health Care. In: The Textbook of Total Quality in Healthcare, pp. 31-39. Al-Assaf & Schmele (eds.). Delray Beach Florida: St Lucie Press.
Meagher, K. (2011). Considering virtue: public health and clinical ethics. Journal of Evaluation in Clinical Practice 17 (5) 888–893.
Frey, R. (1980). Interests and Rights: the case against animals. Oxford: Clarendon Press.
Peabody, F.W. (1928). The soul of the clinic. Journal of the American Medical Association 88, 877-882.
Loughlin, M. (2010). Epistemology, Biology and Mysticism. Journal of Evaluation in Clinical Practice 16 (2) 298-300.
Dupré, J. (2002). Humans and other Animals. Oxford: Oxford University Press.
Ryan, T. (2011). Animals and Social Work: a moral introduction. Basingstoke: Palgrave.
Hursthouse, R. (2000). Ethics, Humans and other Animals. London: Routlege.
Clark, S.R.L. (1984). The Nature of the Beast. Oxford: OUP.
Hutchinson, P. (2008). Shame and Philosophy: an investigation in the philosophy of emotion and ethics. Basingstoke: Palgrave.
Hamilton, R. (2010). The concept of health: beyond normativism and naturalism. Journal of Evaluation in Clinical Practice 16 (2) 323-329.
DOI: http://dx.doi.org/10.5750/ejpch.v2i1.689
Refbacks
- There are currently no refbacks.