Contextualizing science in the aftermath of the evidence-based medicine era: on the need for person-centered healthcare

Abstract

No abstract

Multimorbidity—A manifestation of network disturbances? How to investigate? How to treat?

“…Additionally, and apart from its major conferences and symposia, the ESPCH has embarked on the organisation and delivery of specific training programmes and masterclasses, which are specifically designed to upskill clinicians in the use of condition‐specific guidance and who, following such training, are then able to return to their institutions as teachers, mentors, and leaders. Through such work, which is usefully informed by important studies of multimorbidity such as those being undertaken by Sturmberg et al, the ESPCH has already been able to achieve demonstrable changes within the medical and health care culture, in the thinking of politicians and policymakers and in advising the health care industry in how best to make its own contribution to patient‐centricity . As the ESPCH continues to grow rapidly, so does its expertise and the Society welcome enquiries from all colleagues with an interest in or responsibility for the development of person‐centered health care.…”

Person-Centered Healthcare - moving from rhetoric to methods, through implementation to outcomes

“…A neglect of the duty to understand and respond to the patient's subjective experience of illness and the plethora of important needs which derive from it has, over recent decades, seen clinicians function more in the manner of technicians in applied bioscience, delivering modalities dictated by algorithmic guidance and commissioner/reimbursement-dictated protocols, rather than acting as caring professionals exercising skill and judgement in the context of the unique individual case [51]. Leading commentators, reflecting on the same, have lamented the loss of doctors' abilities to care for their patients as integral human beings, warning that a continued depersonalisation of clinical practice risks an essential "failure" of healthcare provision [52] and a maintenance of patients' complaints that they are treated not as persons, but rather 'dealt with' as subjects, objects or complex biological machines [28,42,48].…”

Towards a person-centered medical education: challenges and imperatives (I)

“…Indeed, this movement has aimed, principally, at achieving a re-balancing of medicine's science with medicine's humanism, seeking to remind clinicians that patients' subjective needs (as expressed by them through narratives, values, preferences, and so on) are to be as fully considered as medicine's science when formulating treatwith the science, then it is the values which remain preeminent and which form the basis of decision-making. Importantly, patient-centered medicine has been criticized as an overly consumerist model of care, where the patient is empowered as a customer and the clinician is disempowered into a simple provider of goods [1][2][3][4][5][6][7][8][9][10] . In direct contradistinction, the EBM movement has aimed principally at accelerating the introduction of scientific evidence into "hands on" practice in the clinic and at the bedside, but being preoccupied with biostatistics (and traditionally viewing these as pre-eminent above patients' subjectively expressed needs) has gravely neglected the humanistic character of medicine 1-10 , resulting in the range of unintended consequences for medicine's humanism that EBM leaders now themselves openly acknowledge 29,30 .…”

“…Any coalescence will -constitution, to move from epistemological foundationalism to epistemological non-foundationalism and thus from a scientific evidence-based stance (EBM), to a scientific evidence-informed position (EIM). For this reason, and to make progress towards the development of new clinical methods to deal far more effectively with the current epidemic of multi-morbid, socially complex long term illness, Miles and Asbridge have called for the "collapse" of the vertically ordered "Hierarchy of Evidence" of EBM into a horizontally ordered "Library of Clinical Knowledge Sources" which -ical knowledge of relevance to clinical decision-making and from which the wise clinician can draw, as indicated, with -tient [1][2][3][4][5][6][7][8][9][10] .…”

“…Indeed, it has been contended that if modern Society continues to tolerate this crisis of disregard sad juncture in human history indeed [4][5][6][7] . So what is to be done?…”