Is “scientifically informed, yet humanistic medicine” the solution to the crisis of modern medicine? A friendly corrective to the emergent model of Person-Centered Medicine
Abstract
In Miles and Mezzich’s programmatic paper “The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice”, the authors draw from a wide variety of sources to frame a theoretical underpinning for the emerging concept of “person-centered medicine” as a model of clinical practice. The sources include humanistic and phenomenological medicine, the biopsychosocial model, evidence-based medicine, critics of evidence-based medicine and patient-centered care. Each offer commendable desiderata, which Miles and Mezzich selectively integrate into their burgeoning theoretical framework. My concern is that the selective uptake of desirably qualities from such diverse resources in order to progress person-centered medicine’s developing vision of “medicine for the person, by the person and with the person” obscures important theoretical differences among these sources that will likely result in difficulty for the concept of person-centered medicine. These diverse theoretical resources offer competing correctives to the problems with medicine. Some of these differences are irreconcilable and need to be highlighted in order to avoid creating conceptual confusion and allegiance to unproductive theoretical commitments at this critical point of framing and developing this emergent model of modern clinical practice.
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. 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, 207-222.
Schwartz, M.A. & Wiggins, O. (1985). Science, humanism, and the nature of medical practice: A phenomenological view. Perspectives in Biology and Medicine 28, 331-361.
Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129-136.
Waksler, F.C. (1992). Medicine and the phenomenology of medicine. In: Handbook of Phenomenology of Medicine. (S. Kay Toombs, ed.), pp. 67-86. Dordrecht: Kluwer Academic Press.
Stewart, M. & Brown, J.B. (2003). Patient Centred Care: Transforming the clinical Method. 2nd edn. London: Radcliffe Medical Press.
Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualised care. Journal of Evaluation in Clinical Practice 17, 531-536.
Reiser, S. (1978). Medicine and the reign of technology. New York: Cambridge University Press.
Zaner, R.M. (1988). Ethics and the clinical encounter. Englewood Cliffs, N.J.: Prentice Hall.
Goldenberg, M.J. (2010). Clinical evidence and the absent body in medical phenomenology: on the need for a new phenomenology of medicine. International Journal of Feminist Approaches to Bioethics 3, 43-71.
. Miles, A. (2009). Towards a medicine of the whole person - knowledge, practice and holism in the care of the sick. Journal of Evaluation in Clinical Practice 15, 887-890.
Miles, A. (2011). On a medicine of the whole person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. Journal of Evaluation in Clinical Practice 15, 941-949.
Wartofsky, M. (1978). Editorial. Journal of Medicine and Philosophy 3, 265-272.
McWhinney, I.R. (1978). Medical knowledge and the rise of technology. Journal of Medicine and Philosophy 3, 273-304
Harzband, P. & Groopman, J. (2009). Keeping the patient in the equation – humanism and health care reform. New England Journal of Medicine, 361, 554-555.
Harding, S. (1978). Knowledge, technology, and social relations. Journal of Medicine and Philosophy 3, 346-358.
Peabody, F.W. (1927). The care of the patient. Journal of the American Medical Association 88, 877-882.
. Miles, A. (2012). Moving from a reductive anatomico-pathological medicine to an authentically anthropocentric model of healthcare: current transitions in epidemiology and epistemology and the ongoing development of person-centered clinical practice. International Journal of Person Centered Medicine 2 (4) 615-621.
Baron, R. (1985). An introduction to medical phenomenology: “I can’t hear you while I’m listening.” Annals of Internal Medicine 103, 606–611.
Toombs, S.K. (1992). The body in multiple sclerosis: A patient’s perspective. In: The Body in Medical Thought and Practice. (Leder, D., ed.), pp. 127-137. Dordrecht: Kluwer Academic Publishers.
Toombs, S.K. (1993). The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Dordrecht: Kluwer Academic Publishers.
Leder, D. (1990). The absent body. Chicago: University of Chicago Press.
Leder, D. (1992). A tale of two bodies: the Cartesian corpse and the lived body. In: The Body in Medical Thought and Practice. (Leder, D., ed.), pp. 17-35. Dordrecht: Kluwer Academic Publishers.
Svenaeus, F. (2010). The Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a Philosophy of Medical Practice. New York: Springer.
Tanenbaum, S. (1994). Knowing and acting in medical practice: the epistemological politics of outcomes research. Journal of Health, Politics, Policy, and Law 19, 27-44.
Greenhalgh, T. (1999). Narrative-based medicine in an evidence based world. British Medical Journal 318, 323-327.
Malterud, K. (2001). The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet 358, 397-399.
Tonelli, M.R. (2006). Integrating evidence into clinical practice: an alternative to evidence-based approaches. Journal of Evaluation in Clinical Practice, 12, 248-256.
Shaughnessy, A.F., Slawson, D.C. & Becker, L. (1998). Clinical jazz: harmonizing clinical experience and evidence-based medicine. Journal of Family Practice, 47, 425-428.
Wartofsky, M. (1986). Clinical judgment, expert programs, and cognitive style: a counter-essay in the logic of diagnosis. Journal of Medicine and Philosophy 11, 81-92.
Hunter, K.M. (1996). Narrative, literature, and the clinical exercise of practical reason. Journal of Medicine and Philosophy 21, 303-320.
Tudor Hart, J.T. (1993). Hyptertension guidelines: other diseases complicate management. British Medical Journal 306, 1337.
Horton, R. (2000). Common sense and figures: the rhetoric of validity in medicine. Bradford Hill Memorial Lecture 1999. Statistics in Medicine 19, 3149-3164.
Haynes, R.B. (2002). What kind of evidence is it that evidence-based medicine advocates want health care providers and consumers to pay attention to? BMC Health Services Research 2, 3.
Guyatt, G.H. & Rennie, D., eds. (2002). Users’ guides to the medical literature: A manual for evidence-based clinical practice. Chicago: AMA Press.
Evidence-Based Medicine Working Group. (1992). Evidence-based medicine. Journal of the American Medical Association 268 (17) 2420-2425.
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.
Guyatt, G.H., Cook, D. & Haynes, R.B. (2004). Evidence-based medicine has come a long way. British Medical Journal 329, 990-991.
Djulbegovic, B., Guyatt, G.H. & Ashcroft R. (2009). Epistemological inquiries in evidence based medicine. Cancer Control 16, 158-168.
Upshur, R.E.G. (2002). If not evidence, then what? Or does medicine really need a base? Journal of Evaluation in Clinical Practice 8, 113-119.
Sackett, D.L., Straus, S.E. & Richardson, W.S. (2000). Evidence-Based Medicine: How to Practice and Teach EBM. 2nd edn. Edinburgh: Churchill Livingstone.
Horton, R. (1995). The interpretive turn. Lancet 346, 3.
Feinstein A. & Horwitz R.I. (1997). Problems in the evidence of evidence-based medicine American Journal of Medicine 103, 529-535.
. Pierce, C.S. (1955). Abduction and induction. In: Philosophcial Writings of Pierce.(Buchler, J., ed.). New York: Dover.
Upshur, R.E.G. & Colack, E. (2003). Evidence and argumentation. Theoretical Medicine and Bioethics 24, 283-299.
Jenicek, M. & Hitchcock, D. (2005). Evidence-Based Practice: Logic and Critical Thinking in Medicine. Chicago: American Medical Association Press.
Horton, R. (1998). The grammar of interpretive medicine. Canadian Medical Association Journal 158, 245-249.
Popper, K. (1963). Conjectures and Refutations: The Growth of Scientific Knowledge. London: Routledge.
DOI: http://dx.doi.org/10.5750/ejpch.v2i1.713
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