scholarly journals Medical Concepts with Clinical-Epidemiological Implications that have to be Re-Assessed Since the Coronavirus Disease 2019 (Covid-19) Pandemic

2020 ◽  
Vol 1 (1) ◽  
pp. 17-27
Author(s):  
Jose Luis Turabian
Keyword(s):  
Medical Model ◽  
Big Bang ◽  
Health Centers ◽  
Evidence Based ◽  
Patient Centered ◽  
Centered Care ◽  
Health Model ◽  
Based Medicine ◽  
The Big Bang ◽  
Medical Concepts

The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.

Adaptive many model medicine trumps monocultural models: comment on the Miles and Mezzich emergent model of modern clinical practice

2014 ◽  
Vol 2 (1) ◽  
pp. 64
Author(s):  
Robin Nunn
Keyword(s):  
Evidence Based Medicine ◽  
Medical Model ◽  
Evidence Based ◽  
Multiple Perspectives ◽  
Single Model ◽  
Discussion Paper ◽  
Medical Problems ◽  
Patient Centered ◽  
Centered Care ◽  
Based Medicine

In their provocative and insightful discussion paper, Miles and Mezzich consider two parallel, but philosophically divergent movements in medicine: evidence-based medicine and patient-centered care. They call for the integration or coalescence of these contrasting movements into one model that "combines the strengths of both movements, but which dispenses with the weaknesses of each." I share their goal of placing the person at the center of medicine, rather than subordinating the person to the depersonalized science and technology represented by current models of evidence-based medicine. Yet I envision a person-centered model, indeed any medical model, not as an overriding unified entity, but rather as one component in a complex "many model medicine". I have tried to show elsewhere that the use of many models is likely to produce better outcomes than the dominance of any single model. Multiple models entail multiple perspectives and methods that may be necessary to solve difficult medical problems. This pluralistic view is consistent with Peabody's view, cited in the discussion paper, that medical art and science are not opposites, but are foundational components of medicine.

scholarly journals Varieties of Uncertainty in Health Care

2011 ◽  
Vol 31 (6) ◽  
pp. 828-838 ◽  
Author(s):  
Paul K. J. Han ◽  
William M. P. Klein ◽  
Neeraj K. Arora
Keyword(s):  
Health Care ◽  
Empirical Literature ◽  
Evidence Based ◽  
Shared Decision ◽  
Services Research ◽  
Patient Centered ◽  
3 Dimensional ◽  
Centered Care ◽  
Multiple Meanings ◽  
Based Medicine

Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, in part because of the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care that are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. This article addresses this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology and developing a new integrative conceptual taxonomy of uncertainty. A 3-dimensional taxonomy is proposed that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. It is shown how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis and suggesting appropriate strategies for its analysis and management.

Evidence-based medicine offers an optimal starting point for person-centered medicine

2014 ◽  
Vol 2 (1) ◽  
pp. 76 ◽  
Author(s):  
Piet Post ◽  
Gordon Guyatt
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Patient Centered Care ◽  
Evidence Based ◽  
Discussion Paper ◽  
Patient Centered ◽  
Starting Point ◽  
Centered Care ◽  
Based Medicine

In their discussion paper, Miles and Mezzich argue that evidence-based medicine (EBM) and patient-centered care have developed in parallel, but rarely have entered into exchange and dialogue. These authors emphasize the need for a rational form of integration to take part between EBM and patient-centered care. We agree wholeheartedly with the desirability of both dialogue and integration. The dialogue will be much less likely to be productive, however, when authors ignore or altogether misconstrue the evolution of evidence-based medicine and the recent work of EBM leaders. Statements claiming “a foundational irreconcilability between the fundamental principles of EBM and those of patient-centered care” are not likely to promote enthusiastic dialogue with the EBM community. In this commentary, we demonstrate that EBM has introduced and aggressively advocated for the integration of patient’s values and preferences in the process of clinical decision-making. Furthermore, EBM has highlighted the need for research into optimal ways of integrating patient values and preferences and, most recently, introduced and studied innovative ways of facilitating shared decision-making.

scholarly journals Through a Glass, Darkly: The Challenge of Integration of the Science and the Art of Medicine.

2014 ◽  
Vol 2 (1) ◽  
pp. 46 ◽  
Author(s):  
Peter Wyer ◽  
Suzana Alves Silva
Keyword(s):  
Model Building ◽  
Evidence Based ◽  
Patient Centered ◽  
Healthcare Environment ◽  
Practice Models ◽  
Centered Care ◽  
Humanistic Medicine ◽  
Based Medicine ◽  
Evidence Based Care ◽  
New Phase

We have entered a new phase in the dialogue between proponents of evidence-based medicine and humanistic medicine. Over 30 years of parallel development of patient-centered and evidence-based care make possible concrete approaches to the integration of the fruits of these developments. Such integration is of increasing importance to the viability of today’s highly structured and regulated healthcare environment. Attempts at integrated model building on the part of proponents of both EBM and humanistic care have suffered from common deficiencies. These include the failure to distinguish between decision-making and practice models, failure to illuminate processes traversing categories of knowledge and information, failure to embrace the principles of relationship-centered care and failure adequately to address the epistemological issues inherent to the integration of the experiential and scientific domains of clinical practice. A published model-building attempt is used to illustrate what a correction of such limitations might look like.  Efforts to develop person-centered care as an integrated and patient-centered vision of healthcare are encouraged.

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

2014 ◽  
Vol 2 (1) ◽  
pp. 106 ◽  
Author(s):  
Maya Goldenberg
Keyword(s):  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Modern Medicine ◽  
Evidence Based ◽  
Patient Centered ◽  
Centered Care ◽  
Model Evidence ◽  
Humanistic Medicine ◽  
Based Medicine ◽  
Conceptual Confusion

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. 

scholarly journals Theorising personhood: for better or for worse

2014 ◽  
Vol 2 (1) ◽  
pp. 57
Author(s):  
Miles Little
Keyword(s):  
Human Body ◽  
Emergent Property ◽  
Evidence Based ◽  
Human Beings ◽  
Patient Centered ◽  
Psychological Attributes ◽  
Starting Point ◽  
Centered Care ◽  
Based Medicine ◽  
Made In

Person-centered medicine is emerging as one of the most formidable critiques of evidence-based medicine. One of its claims to priority over patient-centered care, humane medicine, narrative-based medicine and values-based medicine is its attention to the philosophy of personhood. While it defines personhood in widely accepted terms, using adjectives employed by Cassell, such as ‘embodied,   purposeful, thinking, feeling, emotional, reflective, relational’, it offers no examination of the numerous debates and disagreements about personhood. In particular, it has not so far explored the tension that exists between the neo-Lockean account of persistent psychological attributes, such as intention, cognition and rationality and the ‘animalistic’ account that ascribes personhood to human existence, to the human body and brain. Nor has it examined the significance of personhood as an emergent property of human beings imbedded in cultures and societies. Medical ontology is basically realist and its epistemology empiricist. Person-centered medicine faces the task of translating a contested, emergent concept into something realistic and empirically examinable, if it is to persist and have pedagogical purchase. Schectman’s ‘person-life view’ may provide a starting point for conceptualisation and teaching and respect is a relationship that underpins an understanding of personhood, but other guidelines will be needed. Some relevant suggestions are made in this article.

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