scholarly journals Patient-Centered Medicine: A Necessary Condition for the Management of Functional Somatic Syndromes and Bodily Distress

2021 ◽  
Vol 8 ◽  
Author(s):  
Pascal Cathébras

This paper argues that “functional,” “medically unexplained,” or “somatoform” symptoms and disorders necessarily require a patient-centered approach from the clinicians. In the first part, I address the multiple causes of the patients' suffering and I analyze the unease of the doctors faced with these disorders. I emphasize the iatrogenic role of medical investigations and the frequent failure in attempting to reassure the patients. I stress the difficulties in finding the right terms and concepts, despite overabundant nosological categories, to give a full account of psychosomatic complexity. Finally, I discuss the moral dimension attached to assigning a symptom, at times arbitrarily, to a psychogenic origin. The following part presents a brief reminder of the patient-centered approach (PCA) in medicine. In the last part, I aim to explain why and how patient-centered medicine should be applied in the context of functional disorders. First, because PCA focuses on the patients' experience of illness rather than the disease from the medical point of view, which is, indeed, absent. Second, because PCA is the only way to avoid sterile attribution conflicts. Last, because PCA allows doctors and patients to collaboratively create plausible and non-stigmatizing explanations for the symptoms, which paves the way toward effective management.

2020 ◽  
Vol 28 (11) ◽  
pp. 565-570
Author(s):  
R. Stoevelaar ◽  
A. Brinkman-Stoppelenburg ◽  
R. L. van Bruchem-Visser ◽  
A. G. van Driel ◽  
R. E. Bhagwandien ◽  
...  

Abstract The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians’ lack of time, difficulties in finding the right time to discuss ICD deactivation, patients’ reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inappropriate and painful shocks in the terminal stage of their lives.


2019 ◽  
Vol 9 (1) ◽  
pp. 50-63
Author(s):  
Eugenia Cao di San Marco ◽  
Elena Vegni ◽  
Lidia Borghi

The goal of this chapter is to describe some of the recent challenges that modern medicine is facing using patient-centered medicine as a theoretical frame of reference. First, the work will describe the origin, the development, and the main implications of patient-centered medicine (PCM). Then, it will address the critical increase of chronic illnesses and how PCM could be the best-suited theoretical framework for enhancing patient engagement and coping with chronicity. Additionally, it will address the difficulties raised by increased uncertainty in medical practice, especially from the physicians' point of view. Finally, a relationship-centered care (RCC) will be proposed as a more effective theoretical perspective than PCM to deal with uncertainty and its impact on the patients' and physicians' inner life.


Author(s):  
David H. Rosen ◽  
Uyen Hoang

Patient-Centered Medicine: A Human Experience emphasizes the health professional’s role in caring for patients as unique individuals by focusing on patients’ psychological and social realities as well as their biological needs. The text concerns itself with caring for the whole patient, and outlines the basic principles (acceptance, empathy, conceptualization, and competence) involved in developing a biopsychosocial approach to medical practice. This is a volume of guidelines to help you to develop and master the following: basic attitudes (awareness, disorganization, and reorganization) and interviewing skills; the realization that the experience of illness depends on the person, challenges of illness, coping, problem patients, the nature of the healing process, touching, healing and the biopsychosocial model, medicine’s existential quest, and desiderata. According to Andrew Weil, MD, “Patient-Centered Medicine: A Human Experience is a timely and welcome publication …. Integrative medicine also emphasizes the importance of the practitioner–patient relationship in the healing process…. Medical students and doctors in training will find it especially useful” (Foreword, this edition) According to Norman Cousins, “[this is] a book filled with compassion and insight … attach the highest value to your science… it is our respect for the human soul that determines the worth of our science” (Foreword, 1st edition).


2018 ◽  
Vol 3 (5) ◽  
pp. 39
Author(s):  
Yéssica Elizabeth Barreto Macías ◽  
Colón Avellán Velásquez

El actual trabajo afronta una de las problemáticas más apremiantes de los actuales momentos como es el alto índice de dispendio de drogas en las Instituciones Educativas, que afectan considerablemente a la sociedad ecuatoriana. Su objetivo es analizar los lineamientos que permitan mejorar la orientación familiar, y desarrollar relaciones interpersonales apropiadas que fomenten la unión familiar, practicar principios, fomentar valores morales, y que los jóvenes aprendan a decir “no” ante una eventual propuesta de consumir compuestos prohibidos, que lo único que se consigue es materializarse en un estado no idóneo ante la comunidad, considerar que las consecuencias para la salud son devastadoras, personas que a temprana edad padecen de enfermedades que en muchas ocasiones son gravísimas, causando malestar no solamente propio sino a la familia. Puedo mencionar como aporte de este artículo; y en base a resultados establecidos que resulta primordial e importante mantener la asistencia de un profesional especializado en psicología, diálogos científicos y motivadores, conjuntamente con atención médica provocarán en la persona afectada la erradicación del consumo de drogas. Constan muchos factores que causan gran influencia negativa en las familias, partiendo de que actualmente el mundo vive la tendencia del consumismo lo que influye en sobremanera que exista menos dialogo en el hogar, la aparición de la tecnología es otra de las situaciones adversas. Los profesionales encargados de brindar orientación familiar deben considerar siempre, que el comportamiento del ser humano debe ser comprendido desde el punto de vista de su forma de pensar, solo así se desarrollara una cultura que permita a las familias tomar las decisiones acertadas al momento de formar a sus hijos, lo que en un futuro se evidenciará como seres útiles a la sociedad. PALABRAS CLAVE: Consumo de drogas; orientación familiar; valores morales.  FAMILY COUNSELING, FOR THE PREVENTION OF DRUG USE IN THIRDYEAR HIGH SCHOOL STUDENTS  ABSTRACT  The current work addresses one of the most pressing issues of current times such as the high rate of drug use in educational institutions, which greatly affect Ecuadorian society. Its objective is to analyze the guidelines for improving family orientation, and develop appropriate interpersonal relationships that promote family unity, value the principles, and that young people learn to say "no" to a possible proposal to use prohibited drugs, that the only thing that is achieved is to materialize in an unsuitable state before the community, to consider that the consequences for health are devastating, people who at an early age suffer from diseases that in many occasions are very serious, causing discomfort not only their own but also the family. I can mention as contribution of this article; and based on established results that it is essential and important to maintain the assistance of a professional specialized in psychology, scientific and motivational dialogues, together with medical care, will cause the affected person to eradicate drug use. There are many factors that cause great negative influence on families, based on the fact that the world currently lives the trend of consumerism which greatly influences that there is less dialogue at home, the emergence of technology is another of the adverse situations. The professionals responsible for providing family counseling should always consider that the behavior of the human being should be understood from the point of view of their way of thinking, only in this way will a culture be developed that allows families to make the right decisions when forming to their children, which in the future will be evident as useful beings to society. KEYWORDS: drug use; family orientation; moral values.


Erkenntnis ◽  
2021 ◽  
Author(s):  
Camden Alexander McKenna

AbstractI argue for constraining the nomological possibility space of temporal experiences and endorsing the Succession Requirement for agents. The Succession Requirement holds that the basic structure of temporal experience must be successive for agentive subjects, at least in worlds that are law-like in the same way as ours. I aim to establish the Succession Requirement by showing non-successively experiencing agents are not possible for three main reasons, namely that they (1) fail to stand in the right sort of causal relationship to the outcomes of their actions, (2) exhibit the wrong sort of epistemic status for agency, and (3) lack the requisite agentive mental attitude of intentionality. I conclude that agency is incompatible with non-successive experience and therefore we should view the successive temporal structure of experience as a necessary condition for agency. I also suggest that the Succession Requirement may actually extend beyond my main focus on agency, offering preliminary considerations in favor of seeing successive experience as a precondition for selfhood as well. The consequences of the Succession Requirement are wide-ranging, and I discuss various implications for our understanding of agency, the self, time consciousness, and theology, among other things.


2019 ◽  
Vol 28 (04) ◽  
pp. 708-724
Author(s):  
ANDREA LAVAZZA ◽  
VITTORIO A. SIRONI

Abstract:The microbiome is proving to be increasingly important for human brain functioning. A series of recent studies have shown that the microbiome influences the central nervous system in various ways, and consequently acts on the psychological well-being of the individual by mediating, among others, the reactions of stress and anxiety. From a specifically neuroethical point of view, according to some scholars, the particular composition of the microbiome—qua microbial community—can have consequences on the traditional idea of human individuality. Another neuroethical aspect concerns the reception of this new knowledge in relation to clinical applications. In fact, attention to the balance of the microbiome—which includes eating behavior, the use of psychobiotics and, in the treatment of certain diseases, the use of fecal microbiota transplantation—may be limited or even prevented by a biased negative attitude. This attitude derives from a prejudice related to everything that has to do with the organic processing of food and, in general, with the human stomach and intestine: the latter have traditionally been regarded as low, dirty, contaminated and opposed to what belongs to the mind and the brain. This biased attitude can lead one to fail to adequately consider the new anthropological conceptions related to the microbiome, resulting in a state of health, both physical and psychological, inferior to what one might have by paying the right attention to the knowledge available today. Shifting from the ubiquitous high-low metaphor (which is synonymous with superior-inferior) to an inside-outside metaphor can thus be a neuroethical strategy to achieve a new and unbiased reception of the discoveries related to the microbiome.


2003 ◽  
Vol 34 (3) ◽  
pp. 516-526 ◽  
Author(s):  
Yuji Takano

Since the emergence of Kayne's (1994) stimulating proposal for an antisymmetric theory of phrase structure and linear order, much work has been devoted to arguing for or against his theory as well as discussing its empirical predictions. As a result, for a number of phenomena involving rightward positioning, such as rightward adjuncts, heavy NP shift, extraposition, postverbal subjects, and postverbal constituents in OV languages, there now exist both an approach consistent with Kayne's theory (the antisymmetric approach) and another not consistent with it (the symmetric approach). In such a situation, it is often difficult to show on empirical grounds that one approach is superior to the other (see Rochemont and Culicover 1997). In what follows, I describe this situation with respect to two well-known phenomena in English: rightward positioning of adjuncts and heavy NP shift. For each of these phenomena, the symmetric and antisymmetric approaches have been proposed, and both approaches can correctly account for the data discussed in previous studies. Here, I examine the approaches from a novel point of view, showing that data involving the licensing of negative polarity items allow us to differentiate them and to decide which is the right one for each of the two empirical domains. Interestingly, the relevant facts lead to different conclusions for the two phenomena. The results have important implications for the antisymmetric view of syntax.


Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1995
Author(s):  
Salvatore Nicola Bertuccio ◽  
Laura Anselmi ◽  
Riccardo Masetti ◽  
Annalisa Lonetti ◽  
Sara Cerasi ◽  
...  

Despite improvements in therapeutic protocols and in risk stratification, acute myeloid leukemia (AML) remains the leading cause of childhood leukemic mortality. Indeed, the overall survival accounts for ~70% but still ~30% of pediatric patients experience relapse, with poor response to conventional chemotherapy. Thus, there is an urgent need to improve diagnosis and treatment efficacy prediction in the context of this disease. Nowadays, in the era of high throughput techniques, AML has emerged as an extremely heterogeneous disease from a genetic point of view. Different subclones characterized by specific molecular profiles display different degrees of susceptibility to conventional treatments. In this review, we describe in detail this genetic heterogeneity of pediatric AML and how it is linked to relapse in terms of clonal evolution. We highlight some innovative tools to characterize minor subclones that could help to enhance diagnosis and a preclinical model suitable for drugs screening. The final ambition of research is represented by targeted therapy, which could improve the prognosis of pediatric AML patients, as well as to limit the side toxicity of current treatments.


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