Person-Centered Medicine: An Existential Outline beyond the Biopsychosocial Model

2016 ◽  
Vol 6 (3) ◽  
pp. 146-154
Author(s):  
Roger Ruiz-Moral
Keyword(s):  
Decision Making ◽  
Biopsychosocial Model ◽  
Decisive Role ◽  
Clinical Effectiveness ◽  
Clinical Activity ◽  
Clinical Approach ◽  
Patient Relationship ◽  
Medical Problems ◽  
Relational Perspective ◽  
Educational Challenges

Starting from the idea that “medical problems” are always “problems of living” that reflect the existence of a “vital dimension” that is different from the biological, psychological and sociocultural dimensions, this article describes central features of this dimension. From this viewpoint, its inescapable importance in the clinical act is highlighted, an importance that shapes the tasks that are inherent to it – diagnosis and decision making – but also the very process of the doctor-patient relationship. It is argued that “the subjective truth” implicit in the “vital dimension” (in the “existential self”) can only be approached through reflection and interpretation in the context of a dialogue between the professional and the patient/family with the objective of deciding on the action(s) that can better lead to reaching some concrete wishes or desires (values), that in turn require the participants to take on obligations and responsibilities. This relational perspective defines the “person centered” clinical approach as a practice based on dialogue, importantly involving deliberation and collaboration (“collaborative deliberation”). In this dialogue, the emotions, integral elements of the life dimension of its protagonists, play a decisive role both in attaining clinical effectiveness and in building and maintaining the relational process (encouraging or reducing trust) that is indispensable in a clinical activity that is an eminently moral act. Finally, the main challenges that doctors face when implementing this clinical focus and the educational challenges it entails are outlined.

scholarly journals Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Jennifer Wrede-Sach ◽  
Isabel Voigt ◽  
Heike Diederichs-Egidi ◽  
Eva Hummers-Pradier ◽  
Marie-Luise Dierks ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Older Patients ◽  
Self Determination ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Good Doctor ◽  
Patient Decision Making

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

OP179 Quantitative Evidence Synthesis Methods For Assessing The Effectiveness Of Treatment Sequences For Clinical And Economic Decision-Making: Methodology Review

2021 ◽  
Vol 37 (S1) ◽  
pp. 4-4
Author(s):  
Ruth Lewis ◽  
Dyfrig Hughes ◽  
Alex Sutton ◽  
Clare Wilkinson
Keyword(s):  
Decision Making ◽  
Chronic Conditions ◽  
Evidence Synthesis ◽  
Policy Decision ◽  
Clinical Effectiveness ◽  
Synthesis Methods ◽  
Economic Decision Making ◽  
Treatment Sequencing ◽  
Policy Decision Making ◽  
Treatment Sequences

IntroductionThe sequential use of alternative treatments for chronic conditions represents a complex, dynamic intervention pathway; previous treatment and patient characteristics affect both choice and effectiveness of subsequent treatments. Evidence synthesis methods that produce the least biased estimates of treatment-sequencing effects are required to inform reliable clinical and policy decision-making. A comprehensive review was conducted to establish what existing methods are available, outline the assumptions they make, and identify their shortcomings.MethodsThe review encompassed both meta-analytic techniques and decision-analytic modelling, any disease condition, and any type of treatment sequence, but not diagnostic tests, screening, or treatment monitoring. It focused on the estimation of clinical effectiveness and did not consider the impact of treatment sequencing on the estimation of costs or utility values.ResultsThe review included ninety-one studies. Treatment-sequencing is usually dealt with at the decision-modelling stage and is rarely addressed using evidence synthesis methodology for clinical effectiveness. Most meta-analyses are of discrete treatments, sometimes stratified by line of therapy. Prospective sequencing trials are scarce. In their absence, there is no single best way to evaluate treatment sequences, rather there is a range of approaches, each of which has advantages and disadvantages and is influenced by the evidence available and the decision problem. Due to the scarcity of data on sequential treatments, modelling studies generally apply simplifying assumptions to data on discrete treatments. A taxonomy for all possible assumptions was developed, providing a unique resource to aid the critique of decision-analytic models.ConclusionsThe evolution of network meta-analysis in HTA demonstrates that clinical and policy decision-making should account for the multiple treatments available for many chronic conditions. However, treatment-sequencing has yet to be accounted for within clinical evaluations. Economic modelling is often based on the simplifying assumption of treatment independence. This can lead to misrepresentation of the true level of uncertainty, potential bias in estimating the effectiveness and cost effectiveness of treatments and, eventually, the wrong decision.

scholarly journals Management of Pulp Canal Obliteration—Systematic Review of Case Reports

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1237
Author(s):  
Alexandra Vinagre ◽  
Catarina Castanheira ◽  
Ana Messias ◽  
Paulo J. Palma ◽  
João C. Ramos
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Watchful Waiting ◽  
Case Reports ◽  
Intervention Strategy ◽  
Permanent Teeth ◽  
Clinical Approach ◽  
Treatment Pathways ◽  
Patient Reported

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

Overview of Legal Issues in Psychiatry

2017 ◽  
Author(s):  
Tracy D. Gunter
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Forensic Psychiatry ◽  
Medical Decision Making ◽  
Third Parties ◽  
Legal Issues ◽  
Medical Decision ◽  
Patient Relationship ◽  
Treatment Provider ◽  
Regulatory Issues

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared. This review contains 2 figures, 5 tables, and 64 references. Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment 

The Dark Side of Medical Tourism?

Oncology ◽  
2017 ◽  
pp. 203-215
Author(s):  
Malcolm Cooper ◽  
Mayumi Hieda
Keyword(s):  
Decision Making ◽  
Medical Tourism ◽  
Medical Profession ◽  
Human Security ◽  
Healthcare Systems ◽  
Dark Side ◽  
Body Parts ◽  
Medical Problems ◽  
Cultural Behavior ◽  
The Impact

There are 4 principles that should govern the response of the healthcare system in its treatment of individual medical problems. These may be summarized as: 1. medical care should be accessible to all; 2. the principle of patient autonomy should govern decision-making; 3. medical treatment should be recognized as being part of cultural behavior; and, 4. the medical profession should support the benefit of the patient. However, the combination of these with the rising cost of healthcare and the impact of globalization, has led to a dark side for medical tourism. In this situation, both patients and physicians are faced with ethical, human security and sustainability issues. This chapter examines 3 major issues in medical tourism: end of life choice, trafficking in human bodies and body parts, and organ transplants. In the healthcare systems of many countries, these issues can also involve criminal activities.

Computational Methods and Tools for Decision Support in Biomedicine

2009 ◽  
pp. 1-17
Author(s):  
Ioannis Dimou ◽  
Michalis Zervakis ◽  
David Lowe ◽  
Manolis Tsiknakis
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Computational Methods ◽  
Pattern Analysis ◽  
State Of The Art ◽  
Biomedical Informatics ◽  
Feature Space ◽  
Diagnostic Tools ◽  
Methodological Issues ◽  
Medical Problems

The automation of diagnostic tools and the increasing availability of extensive medical datasets in the last decade have triggered the development of new analytical methodologies in the context of biomedical informatics. The aim is always to explore a problem’s feature space, extract useful information and support clinicians in their time, volume, and accuracy demanding decision making tasks. From simple summarizing statistics to state-of-the-art pattern analysis algorithms, the underlying principles that drive most medical problems show trends that can be identified and taken into account to improve the usefulness of computerized medicine to the field-clinicians and ultimately to the patient. This chapter presents a thorough review of this field and highlights the achievements and shortcomings of each family of methods. The authors’ effort has been focused on methodological issues as to generalize useful conclusions based on the large number of notable, yet case-specific developments presented in the field.

Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

1992 ◽  
Vol 1 (1) ◽  
pp. 11-31 ◽  
Author(s):  
David C. Thomasma
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Ethics Committee ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patient Decision Making ◽  
Deontological Ethics ◽  
Ethical Discussion ◽  
Patient Decision

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.

Introduction of emerging medical devices on the market: A new procedure in Belgium

2007 ◽  
Vol 23 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Imgard Vinck ◽  
Mattias Neyt ◽  
Nancy Thiry ◽  
Marleen Louagie ◽  
Dirk Ramaekers
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Insurance ◽  
Cost Effectiveness ◽  
Medical Devices ◽  
Clinical Effectiveness ◽  
Added Value ◽  
Scientific Evaluation ◽  
Medical Technologies ◽  
Organizational Issues

When new medical technologies enter the market, there is often uncertainty about the added value for the patient and for society, hampering well-considered decision making about reimbursement. Current Belgian legislation already offered opportunities for the managed uptake of possibly innovative emerging implants. However, it has also some shortcomings such as the lack of a clear research design, rendering the scientific evaluation of clinical effectiveness, cost-effectiveness, and patient or organizational issues more difficult. Against this background, a new procedure was elaborated by the Belgian health insurance institute and the Belgian Health Care Knowledge Centre.

scholarly journals “I would prefer not to”: Assessing competence to consent in a case of refusal of cancer treatment

2019 ◽  
Vol 14 (1) ◽  
pp. 42-45
Author(s):  
Gustavo B Castellana ◽  
Lilia B Schraiber ◽  
Talita R de Oliveira ◽  
Daniel M de Barros
Keyword(s):  
Decision Making ◽  
Forensic Psychiatry ◽  
Patient Relationship ◽  
Ethical Conflict ◽  
Actual Case ◽  
Clinical Issue ◽  
Case Presentation ◽  
Decision Making Capacity ◽  
Forensic Psychiatric

Background Based on an actual case in which a psychiatrist was called in to assess a patient’s capacity to refuse treatment, the aim of this study is to discuss how to manage this ethical and clinical issue and the dilemmas faced by the medical team. Case presentation: The case involved a 45-year-old female patient diagnosed with breast cancer who refused treatment. Since the mastology team had doubts about the patient’s mental state and given that she refused to consent to surgery, a forensic psychiatric consult was requested. Conclusion The forensic psychiatry team concluded that the patient’s decision-making capacity was preserved. The team suggested some actions to help the specialists deal with the ethical conflict. A reflection is proposed about the role of psychiatrists when an ethical dilemma involving decision-making capacity emerges in clinical situations, elucidating their work not only as physicians who determine diagnoses and conducts, but also as agents of transformation in the doctor–patient relationship.

Evidence-Based Medicine and Headache Patient Management by General Practitioners in Italy

Cephalalgia ◽  
2005 ◽  
Vol 25 (10) ◽  
pp. 767-775 ◽  
Author(s):  
A Bianco ◽  
MM Parente ◽  
E De Caro ◽  
R Iannacchero ◽  
U Cannistrà ◽  
...  
Keyword(s):  
Clinical Trials ◽  
General Practitioners ◽  
Evidence Based Medicine ◽  
Clinical Effectiveness ◽  
Clinical Approach ◽  
Evidence Based ◽  
Sources Of Information ◽  
Headache Patient ◽  
Practice Characteristics ◽  
Based Medicine

The study explores the awareness of technical terms used in evidence-based medicine (EBM) and manner of treating patients with migraine among a random sample of 500 general practitioners (GPs). A mailed questionnaire included questions on GPs' demographics and practice characteristics; awareness of EBM; sources of information about migraine and EBM; and patient's treatment behaviour. Only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on EBM. For two-thirds of GPs, disability is equivalent to illness diagnosis, and this behaviour was more prevalent in those who agreed that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine and that the clinical approach to migraine required an evaluation of clinical effectiveness, in those who treated a lower number of headache patients, who were older, and in those who did not use guidelines. The majority (93.1%) of GPs indicated that it is important to integrate clinical practice and the best available evidence, and this behaviour was significantly more frequent in those who agreed that the clinical approach to migraine required a clinical effectiveness evaluation, that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine, and in those who attended courses on EBM. Training and continuing educational programmes on EBM and guidelines on treatments of headache for GPs are strongly needed.

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