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Moving from a reductive anatomico-pathological medicine to an authentically anthropocentric model of healthcare: current transitions in epidemiology and epistemology and the ongoing development of person-centered clinical practice

Andrew Miles

Abstract


Two major processes of transition are currently occurring within international healthcare which present us with serious challenges but also, to be sure, with considerable opportunities. The first is the epidemiological transition from acute to chronic disease, where 63% of the 57 million global deaths in 2008 were due to chronic illness (principally cardiovascular and chronic respiratory diseases,  diabetes and the cancers), a percentage which, as we enter 2013, is probabilistically now significantly higher, since the trends in incidence and prevalence have remained upward.  The second process of transition is the epistemological transition from medicine’s reductive reliance on purely objective sources of evidence for clinical decision-making to its willingness, even enthusiasm, to embrace the largely subjective sources of evidence represented by so-called ‘patient factors’. The former type of knowledge has been consistently emphasised by the evidence-based medicine (EBM) movement as constituting the basis of medicine and the latter form of knowledge by the patient-centered care (PCC) movement as remaining central to the provision of effective and acceptable care.

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DOI: http://dx.doi.org/10.5750/ijpcm.v2i4.339

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