Open Access Open Access  Restricted Access Subscription or Fee Access

The patient, the illness, the doctor, the decision: negotiating a ‘new way’ through person-centered medicine

Andrew Miles, Juan E. Mezzich


Medicine has a unique understanding of the physical, psychological, spiritual and social dimensions of what it is to be human and nowhere within modern medicine today is the need for greater cognition more acutely necessary than in the understanding of the patient as a person. Concerns with medical humanism, which are increasingly apparent within global healthcare services and policymaking, far from detracting from continuing progress in medicine’s scientific character, enable a far more effective practice of medicine than each can possibly do in isolation from the other. The argumentation for augmentation of this nature enables a re-assertion and a re-establishment of some of the core tenets of medical philosophy and theory that have become progressively lost in over a century of positivistic empiricism. It is argued that unlike the 20th Century which was concerned with rapid scientific progress, the 21st Century should be characterised by a concern with both science and the whole person. In order to achieve such a vision in practice, a continuing articulation of medicine’s scientific nature via the evidence-based medicine (EBM) movement and a continuing articulation of patients’ rights through the person-centered care (PCC) movement, should no longer compete for audition in separate arenas or when together in the manner of a dialogue of the deaf. Rather, the more philosophically tenable components of each model should embark upon a process of coalescence, enabling shared clinical decision-making to be able to take account of a range of human concerns as well as being actively informed by accepted and reliable science. Although such a process will not of itself correct the current crisis in medicine – a crisis of knowledge, care, compassion and costs – it will play a highly valuable part in returning to clinical practice radical concerns for the proper care of the patient and the overt soul of the clinic. Without such progress, healthcare standards will continue to slide, inexorably it seems, to the lowest common denominator that is legally tolerable. The humanistic dimension of medicine is not an optional extra. On the contrary, its application is what separates the physician from the veterinary surgeon. The trajectory we describe can be summarily interrupted in accordance with the new World Health Organisation imperatives, by the development and implementation of person-centered medicine, an emergent model of modern clinical practice.

Full Text:



Miles, A. (2007). Science: a limited source of knowledge and authority in the care of patients. Journal of Evaluation in Clinical Practice 13, 545–563.

Miles, A. (2009). On a Medicine of the Whole Person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. Journal of Evaluation in Clinical Practice 15, 941–949.

Gulland, A (2011). Welcome to the century of the patient. British Medical Journal 342, d2057.

Salzburg Global Seminar (2010). Informing and involving patients in decisions about their medical care, 12-17 December 2010.

Miles, A. & Mezzich, J. E. (2011). Person-centered medicine: identifying the way forward. International Journal of Person Centered Medicine 1 (1), 205–206.

Miles, A. & Mezzich, J. E. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2), 207–222.

Miles, A. & Mezzich, J. E. (2011). Person-centered medicine: advancing methods, promoting implementation. International Journal of Person Centered Medicine 1 (3), 423-428.

Hartzband, P. & Groopman, J. (2009). Keeping the patient in the equation – humanism and health care reform. New England Journal of Medicine 361, 554–555.

Loughlin, M. (2011). What person-centered medicine is and isn’t: temptations for the ‘soul’ of PCM. International Journal of Person Centered Medicine In Press.

ZENIT (2011). Demoting Humans. An interview with John Hass, President of the National Catholic Bioethics Centre USA & Member, Pontifical Academy for Life, Vatican City, Rome (

Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualised care. Journal of Evaluation in Clinical Practice 17 (4), 531-536.

Miles, A. (2009). Towards a Medicine of the Whole Person – knowledge, practice and holism in the care of the sick. Journal of Evaluation in Clinical Practice 15, 887–890.

Miles, A. (2009). Evidence-based medicine: requiescat in pace? Journal of Evaluation in Clinical Practice 15, 924–929.

Callahan, D. (1995). Setting Limits: Medical Goals in an Ageing Society. Washington DC: Georgetown University Press.

Mezzich, J. E. (2007). The dialogal basis of our profession: psychiatry with the person. World Psychiatry 6, 129–130.

World Health Organisation (2010). Global Status Report on Non-communicable Diseases. WHO: Geneva.

Houston, W. (1936). Reported and discussed within the Cambridge History of Medicine. [Porter, R. Ed.]. (2006). Cambridge: Cambridge University Press.



  • There are currently no refbacks.

Comments on this article

View all comments