Abstract:Evidence-based medicine (EBM) continues to be vigorously debated and person-centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement to or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include specific methods and the biomedical model. In this paper I argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem co… Show more
“…They facilitate person‐centred care, holistic clinical management, and provide opportunities for individualised clinical reasoning and communication. The evidence‐based medicine approach to healthcare is not derived from a scientifically neutral ontology but stem from a Humean account for causation . Anjum states that the biomedical model is justified in the assumption of reductionism, for instance, and statistical methods are appropriate for generating individual probabilities if we assume frequentism.…”
Section: Discussionmentioning
confidence: 99%
“…In contrast to this, a dispositional ontology accommodates holism, complexity, heterogeneity, individual propensities, or causal mechanisms to create a person‐centred approach that favours uniqueness. This is summarised by Anjum in Figure .…”
Section: Discussionmentioning
confidence: 99%
“…Conversely, medically unexplained symptoms accompanied with multimorbidity continue to increase . In a traditional biomedical model, conditions are conceptualised, diagnosed, and treated as single discrete entities with illness and suffering ascribed to a certain part of the patient's body such as the back, liver, or the heart . Recent epidemiological evidence suggests that viewing people in this way is increasingly inappropriate as comorbidity and multimorbidity are normal in contemporary medicine and facilitate “silo‐based” treatment and management .…”
This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context‐sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient‐practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.
“…They facilitate person‐centred care, holistic clinical management, and provide opportunities for individualised clinical reasoning and communication. The evidence‐based medicine approach to healthcare is not derived from a scientifically neutral ontology but stem from a Humean account for causation . Anjum states that the biomedical model is justified in the assumption of reductionism, for instance, and statistical methods are appropriate for generating individual probabilities if we assume frequentism.…”
Section: Discussionmentioning
confidence: 99%
“…In contrast to this, a dispositional ontology accommodates holism, complexity, heterogeneity, individual propensities, or causal mechanisms to create a person‐centred approach that favours uniqueness. This is summarised by Anjum in Figure .…”
Section: Discussionmentioning
confidence: 99%
“…Conversely, medically unexplained symptoms accompanied with multimorbidity continue to increase . In a traditional biomedical model, conditions are conceptualised, diagnosed, and treated as single discrete entities with illness and suffering ascribed to a certain part of the patient's body such as the back, liver, or the heart . Recent epidemiological evidence suggests that viewing people in this way is increasingly inappropriate as comorbidity and multimorbidity are normal in contemporary medicine and facilitate “silo‐based” treatment and management .…”
This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context‐sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient‐practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.
“…The first is that the nature of clinical observations is not (or at least should not be) limited to the physiological sphere. Use of medications can be associated with complex conditions, where the outcome of a treatment and its side effects are rooted in areas beyond the purely biological . Causal agents for effects like suicide, addiction, and insomnia are complex and multiple, a drug treatment being only one of the suspected causes.…”
Section: Summary Of the Arguments And Implicationsmentioning
The cultural divide between scientists and clinicians has been described as undermining the advance of medical science, by hindering the production of practice-relevant research and of research-informed clinical decisions. Here, I consider the field of post-marketing risk assessment of drugs as an example of strict interdependence between basic biomedical research, clinical research, and clinical evaluation and show how it would benefit from a closer collaboration between scientists and clinicians. The risk assessment of drugs after their marketing relies on spontaneous adverse effect reports to drug agencies and on peer-reviewed case reports. I emphasize the importance of qualitative analysis of such reports for the improvement of mechanistic understanding of harmful effects of drugs. I argue that mechanistic explanations of drug effects are at least as important as determination of their frequency, in order to establish causation. An ideal risk assessment, then, verifies not only the frequency of undesired effects but also why and how the harm happens. For this purpose, the frequency or novelty of the unintended outcome, although contextually indicative, should not determine the epistemic value of a report.Details about the context that generated an unexpected outcome, instead, can offer the chance of improving causal understanding about how the intervention works. This is illustrated through examples from medical research. Mechanistic understanding is a domain of joint collaboration among (1) clinicians, in charge of detailed, qualitative reporting of patient stories about side effects, (2) qualitative clinical researchers, in charge of analyzing clinical contexts or harmful effects and formulating explanatory hypotheses, and (3) basic biomedical researchers, in charge of verifying such hypotheses. In addition, direct information flow can on one side focus clinicians' attention on knowledge gaps about drugs/effects where more research is needed, while on the other side create a more contextualized concept of mechanism among scientists.
“…Anjum has recently advanced a brand of ontological relativism, positioning person‐centered healthcare (PCH) in relation to evidence‐based medicine (EBM) such that “the choice between them ultimately comes down to ontological preference.” On this view, it would seem, idealism and realism are to be regarded as akin to sexual orientations, constituting arbitrary and equally valid metaphysical commitments that determine which kind of healthcare we are bound to love. As if to underscore her relativism, Anjum appeals in Kuhnian fashion to “a paradigmatic revolution on the way in medicine,” then proceeds to discuss this revolution quasi‐impartially as a historical movement that will be driven primarily by ontological shifts.…”
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