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The precarious future of the discourse of person-centered medicine

Miles Little

Abstract


Discourses are more than just patterns of words. For discourse communities, they express ideologies and provide meanings that can be translated into action. They are vehicles for reform when they thrive. The discourse of person-centered medicine has had a vigorous start, with identifiable leaders, a vocabulary which has situated meanings, institutions such as meetings, letterheads and a college and a group of adherents that constitute a discourse community. For a discourse to thrive, its founding problematic has to be perceived as ‘real’ by its target audience – in this case, presumably, healthcare workers. Real in this sense can be defined as something perceived to have an influence on foundational values, for better or for worse. It is not yet clear that the discourse of person-centered medicine has convinced its target audience of the ‘crisis of knowledge, care, compassion and costs’ that it invokes to justify its proposed paradigm shift. In order to make it thrive, those who drive the discourse will need to ‘realise’ both the crisis it addresses and the outcomes it may achieve.

Keywords


Contemporary medicine, discourse, discourse community, entropy, evidence-based medicine, founding problematic, patient-centered care, person-centered medicine, types of discourse

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Swales, J.M. (1990). Genre Analysis: English in Academic and Research Settings. Cambridge: Cambridge University Press.

Gee, J.P. (1999). An Introduction to Discourse Analysis: Theory and Method. London: Routledge.

Little, M. & Lipworth, W. (2008). Focused Discourse. Sydney: Centre for Values, Ethics and the Law in Medicine.

Little, M. (2010). Is there a real nexus between ethics and aesthetics? Journal of Bioethical Inquiry 7, 91-102.

Little, M., Jordens, C.F.C., Paul, K. & Sayers, E-J. (2002). Survivorship and discourses of identity. Psycho-oncology 11 (2) 170-178.

Little, M., Jordens, C.F.C., Paul, K., Sayers, E-J., Cruickshank, J.A., Stegeman, J. & Montgomery, K. (2002). Discourse in different voices: Reconciling n=1 and n=many. Social Science & Medicine 55 (7) 1079-1087.

Little, M., Jordens, C.F.C. & Sayers, E-J. (2003). Discourse communities and the discourse of experience. Health 7 (1) 73-86.

Hartwig, M. (Ed.). (2007). Dictionary of Critical Realism. London: Routledge.

Althusser, L. (2005). For Marx. London: Verso.

Berkenhotter, C. &Huckin, T.N. (1995). Genre Knowledge in Disciplinary Communication: Cognition/Culture/Power. Hillsdale: Erlbaum.

Guyatt, G., Cairns, J.,Churchill, D. et al., (‘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, 2420-2425.

Green, J. &Britten, N. (1998). Qualitative research and evidence based medicine. British Medical Journal 316 (7139) 1230-1232.

Kerridge, I., Lowe, M. & Henry, D. (1998). Personal paper: Ethics and evidence based medicine. British Medical Journal 316 (7138) 1151-1153.

Harari, E. (2001). Whose evidence? Lessons from the philosophy of science and the epistemology of medicine. Australian & New Zealand Journal of Psychiatry 35, 724-730.

Upshur, R. (2002). If not evidence, then what? Or does medicine really need a base? Journal of Evaluation in Clinical Practice 2, 113-119.

Worrall, J. (2002). What Evidence in Evidence-Based Medicine? Philosophy of Science 69 (3) S316-S330.

Little, M. (2003). Better than numbers...: A gentle critique of evidence-based medicine. Australian & New Zealand Journal of Surgery 73, 177-182.

Kravitz, R.L., Duan, N. & Braslow, J. (2004). Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages. The Milbank Quarterly 82 (4) 661-687.

Goldenberg, M.J. (2006). On evidence and evidence-based medicine: Lessons from the philosophy of science. Social Science & Medicine 62, 2621-2632.

Grossman, J. (2008). A Couple of the Nasties Lurking in Evidence-Based Medicine. Social Epistemology: A Journal of Knowledge, Culture and Policy 22 (4) 333-352.

La Caze, A. (2008). Evidence-Based Medicine Can’t Be…. Social Epistemology: A Journal of Knowledge, Culture and Policy 22 (4) 353-370.

Lipworth, W., Carter, S. & Kerridge, I. (2008). The "EBM movement": where did it come from, where is it going, and why does it matter? Social Epistemology: A Journal of Knowledge, Culture and Policy 22, 425-431.

Miller, C.G. & Miller, D.W. (2011). The Real World Failure of Evidence-Based Medicine. International Journal of Person Centered Medicine 1 (2) 295-300.

Eddy, D.M. (1992). Medicine, money and mathematics. American College of Surgeons Bulletin 77, 36-49.

Eddy, D.M. (1997). Balancing cost and quality in fee-for-service versus managed care. Health Affairs 16 (3) 162-173.

Eddy, D.M. (1998). Performance measurement: problems and solutions. Health Affairs 17 (4) 7-25.

Unit for Evidence Based Practice and Policy. (1997). Fourth UK workshop on teaching evidence-based practice study pack. London, University College London Medical School.

Guyatt, G.H., Meade, M.O., Jaeschke, R.Z., Cook, D.J. & Haynes, R.B. (2000). Practitioners of evidence based care: Not all clinicians need to appraise evidence from scratch but all need some skills. British Medical Journal 320 (7240) 954-955.

Mykhalovskiy, E. (2003). Evidence-based medicine: ambivalnet reading and the clinical recontextualiztion of science. Health 7 (3) 331-352.

Darrow, K.K. (1944). Entropy. Proceedings of the American Philosophical Society 87 (5) 365-367.

Shannon, C.E. (1948). A mathematical theory of communication. Bell System Technical Journal 27, 379-423, 623-656.

Wicken, J.S. (1987). Entropy and Information: Suggestions for Common Language. Philosophy of Science 54 (2) 176-193.

Bailey, K.D. (1990). Social Entropy Theory: An overview. Systemic Practice and Action Research 3 (4) 365-382.

Huet, M-H. (1997). Social Entropy. Yale French Studies 92, 171-183.

Bailey, K.D. (2008). Boundary maintenance in living systems theory and social entropy theory. Systems Research and Behavioral Science 25 (5) 587-597.

Yank, V., Tuohy, C.V., Logan, A.C., Bravata, D.M., Staudenmayer, K., Eisenhut,R., Sundaram, V., McMahon, D., Olkin, I., McDonald, K.M. Owens, D.K.. & Stafford, R.S. (2011). Systematic review: Benefits and harms of in-hospital use of recombinant factor VIIa for off-label indications. Annals of Internal Medicine 154, 529-540.

Yank, V., Tuohy, C.V., Logan, A.C., Bravata, D.M. Staudenmayer, K., Eisenhut, R., Sundaram, V., McMahon, D., Olkin, I., McDonald, K.M., Owens, D.K. & Stafford, R.S. (2011). Systematic review: benefits and harms of in-hospital use of recombinant Factor VIIa for off-label indications. Annals of Internal Medicine 154, 529-540.

Schram, S.R. (1971). Mao Tse-tung and the Theory of the Permanent Revolution, 1958-69. The China Quarterly 46, 221-244.

Osler, W. (1948). Aequinimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine. London: H K Lewis & Co.

Rutstein, D.D. (1969). Ethical Aspects of Experimentation with Human Subjects. Daedalus 98 (2) 523-541.

Katz, J. (1992). Abuse of human-beings for the sake of science. In: When Medicine Went Mad: Bioethics and the Holocaust, pp. 233-270. (A.L. Caplan, ed.). Totowa, NJ: Human Press.

Weindling, P.J. (2005). Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent. Basingstoke: Palgrave Macmillan.

Guyatt, G. (1991). Evidence-based medicine. ACP Journal Club (Annals of Internal Medicine) 14 (Supplement 2) A-16.

The 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, 2420-2425.

Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B. & Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal 312 (7023) 71-72.

Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W. & Haynes, R.B. (2000). Evidence-Based Medicine: How to practice and teach EBM. New York: Churchill Livingstone.

Ellrodt, G., Cook, D., Lee, J., Cho, M., Hunt, D. & Weingarten, S. (1997). Evidence-based disease management. Journal of the American Medical Association 278, 1687-1692.

Derkatch, C. (2008). Method as Argument: Boundary Work in Evidence-Based Medicine. Social Epistemology: A Journal of Knowledge, Culture and Policy 22 (4) 371-388.

Skrabanek, P. (1994). The Death of Humane Medicine. Bury St Edmunds: Social Science Unit.

Little, M. (1995). Humane Medicine. Cambridge: Cambridge University Press.

Kerridge, I., Jordens, C. & Sayers, E-J. (Eds.). (2003). A Miles Little Reader: Restoring Humane Values to Medicine. Sydney: Desert Pea Press.

Mead, N. & Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science & Medicine 51, 1087-1110.

Keirns, C. & Dorr Goold, S. (2009). Patient-centered care and preference-sensitive decision making. Journal of the American Medical Association 302, 1805-1806.

Montgomery, K. & Little, M. (2011). Enriching patient-centered care in serious illness: a focus on patients' experiences of agency. Milbank Quarterly 89 (3) 381-398.

Raman, R. (2011). Evidence-based Medicine and Patient-centered Care: Cross-Disciplinary Challenges and Healthcare Information Technology-enabled Solutions. International Journal of Person Centered Medicine 1 (2) 279-294.

Epstein, R.M. & Street, R.L. (2011 ). The values and value of patient-centered care. Annals of Family Medicine 9 (2) 100-103.

Greenhalgh, T. & Hurwitz, B. (Eds.). (1998). Narrative Based Medicine: Dialogue and Discourse in Clinical Practice. London: BMJ Books.

Ellis, C. & Bochner, A.P. (1999). Bringing emotion and personal narrative into medical socail science. Health 3 (2) 229-238.

Mattingly, C. & Garro, L.C. (Eds.). (2000). Narrative and the Cultural Construction of Illness. Berkeley: University of California Press.

Charon, R. (2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. Journal of the American Medical Association 286 (15) 1897-1902.

Charon, R. & Montello, M. (Eds.). (2002). Stories Matter: The Role of Narrative in Medical Ethics. New York: Routledge.

Epstein, R.M. (1999). Mindful Practice. Journal of the American Medical Association 282 (9) 833-839.

Krasner, M.S., Epstein, R.M., Beckman, H., Suchman, A.L., Chapman, B., Mooney, C.J. & Quill, T.E. (2009). Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.Journal of the American Medical Association 302 (12) 1284-1293.

Little, M. (2002). Humanistic medicine or values-based medicine? What's in a name? Medical Journal of Australia 177 (6) 319-321.

Fulford, K.W.M. (2004). Fact/values: ten principles of values-based medicine. In: The Philosophy of Psychiatry: A Companion, pp. 205-234. (J. Radden, ed.). Oxford: Oxford University Press.

Fulford, K.W.M. (2007). Values-based medicine: delusion and religious experience as a case study in the limits of medical-scientific reduction. In: The Science of Morality. (G. Walker, ed.) London: Royal College of Physicians.

Fulford, K.W.M. (2010). Bringing together values-based and evidence-based medicine: UK Department of Health Initiatives in the 'Personalization' of Care. Journal of Evaluation in Clinical Practice 17 (2) 341-343.

Little, M., Lipworth, W., Gordon, J., Markham, P. & Kerridge, I. (2011). Values-based medicine and modest foundationalism. Journal of Evaluation in Clinical Practice In press.

Little, M., Lipworth, W., Gordon, J., Markham, P. & Kerridge, I. (2011). Another argument for values-based medicine. International Journal of Person Centered Medicine 1 (4) 649-656.

Little, M., Gordon, J., Lipworth, W., Markham, P. ∧ Kerridge, I. (2012). Values as 'modest foundations' for medicine. International Journal of Person Centered Medicine In press.

Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualized care. Journal of Evaluation in Clinical Practice 17, 531-536.

Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Miles, A. & Mezzich, J.E. (2011). Person-centered Medicine: advancing methods, promoting implementation. International Journal of Person Centered Medicine 1 (3) 423-428.

Davis, F.D. (1997). Phronesis, clinical reasoning and Pellegrino's philosophy of medicine. Theoretical Medicine and Bioethics 18 (1) 173-195.

Kuhn, T.S. (1970). The Structure of Scientific Revolutions. Chicago, Illinois: University of Chicago Press.

Jenkinson, C., Coulter, A., Bruster, S., Richards, N. & Chandola, T. (2002). Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality and Safety in Health Care 11 (4) 335-339.

Gillies, R.R., Chenok, K.E., Shortell, S.M., Pawlson, G. & Wimbush, J.J. (2006). The Impact of Health Plan Delivery System Organization on Clinical Quality and Patient Satisfaction. Health Services Research 41 (4) 1181-1191.

Hardie, E.A. & Critchley, C.R. (2008). Public perceptions of Australia’s doctors, hospitals and health care systems. Medical Journal of Australia 189 (4) 210-214.

Little, M., Gordon, J., Markham, P., Lipworth, W. & Kerridge, I. (2011). Making decisions in the mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners. International Journal of Person Centered Medicine 1 (2) 376-384.

Little, M., Gordon, J., Markham, P., Rychetnik, L. & Kerridge, I. (2011). Virtuous acts as practical medical ethics: an empirical study. Journal of Evaluation in Clinical Practice 17, 948-953.

Donelan, K., Blendon, R.J., Schoen, C., Davis, K. & Binns, K. (1999). The cost of health system change: public discontent in five nations. Health Affairs 18 (3) 206-216.

Sen, A. (1993). Capability and well-being. In: The Quality of Life, pp. 30-35. (M. Nussbaum & A. Sen, (eds.). Oxford: Clarendon Press.

Thomas, W.I. & Thomas, D.S. (1928). The Child in America: Behavior Problems and Programs. New York: Knopf.

Fletcher, H. (1913). Fletcherism: what it is: or How I became young at 60. London: Ewart, Seymour & Co., Ltd.

Peabody, F.W. (1927). The care of the patient. Journal of the American Medical Association 88 (12) 877-882.

Little, M. (2000). Ethonomics - the ethics of the unaffordable. AMA Archives of Surgery 135, 17-21.

Stewart, M., Brown, J.B., Donner, A., McWhinney, I.R., Oates, J., Weston, W.W. & Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of Family Practice 49 (9) 796-804.

Bertakis, K.A. & Azari, R. (2011). Patient-centered care is associated with decreased health care utilisation. Journal of the American Board of Family Medicine 24, 229-239.

Ekman, I., Wolf, A., Olsson, L-E., Taft, C., Dudas, K., Schaufelberger, M. & Swedberg, K. (2012). Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. European Heart Journal 33 (9) 1112-1119.

Brown, J. B., Boles, M., Mullooly, J.P. & Levinson, W. (1999). Effect of Clinician Communication Skills Training on Patient Satisfaction. Annals of Internal Medicine 131 (11) 822-829.

Joosten, E.A.G., DeFuentes-Merillas, L., de Weert, G.H., Sensky, T., van der Staak, C.P.F. & de Jong, C.A.J. (2008). Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status. Psychotherapy and Psychosomatics 77 (4) 219-226.

Stanovich, K.E. (2001). The Rationality of Educating for Wisdom. Educational Psychologist 36 (4) 247-251.

Engel, G.L. (1978). The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Science 310, 169-187.

Pellegrino, E.D. & Thomasma, D.C. (1993). The Virtues in Medical Practice. New York: Oxford University Press.

Doyal, L. & Gillon, R. (1998). Medical ethics and law as a core subject in medical education. British Medical Journal 316, 1623-1624.

Greenhalgh, T. (2002). Intuition and evidence - uneasy bedfellows? British Journal of General Practice 52 (478) 395-400.

Campbell, A.V. (2003). The Virtues (And Vices) of the Four Principles. Journal of Medical Ethics 29 (5) 292-296.

Bryan, C.S. & Babelay, A.M. (2009). Building character: A model for reflective practice. Academic Medicine 84 (9) 1283-1288.

Bauman, Z. (1995). Postmodern Ethics. Oxford: Blackwell Publishers.

Kant, I. (1824). Idea of a universal history on a cosmo-political plan. London Magazine. 10, 385-393.

Garvin, L. (1953). A Modern Introduction to Ethics. Cambridge, MA: Houghton Mifflin.




DOI: http://dx.doi.org/10.5750/ejpch.v2i1.699

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