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

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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.

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Author Biography

Andrew Miles, WHO Centre for Public Health Education and Training, Imperial College, London

Editor-in-Chief, International Journal of Person Centered Medicine & Professor of Clinical Epidemiology and Social Medicine, Medical School, University of Buckingham, UK Professor Miles, MSc, MPhil, PhD is a senior public health scientist. He previously held professorships and senior fellowships at King’s College University of London, Queen Mary College University of London, the University of East London, the University of Westminster, the University of Surrey and the University of Wales.He is Editor-in-Chief and Chairman of the International Advisory Board of the Journal of Evaluation in Clinical Practice, a leading and highly ranked international periodical for public health policy and health services research published by Wiley Blackwell Ltd with high impact factor and citation rate and extensive world circulation.Professor Miles is National Director and Editor-in-Chief of the UK Key Advances in Clinical Practice Series, a major collaboration between medical Royal Colleges and UK specialist clinical societies in a multi-disciplinary contribution to the evaluation and development of clinical practice in the UK, resulting in the organisation of some 22 annually recurring national conferences and some 22 annually updated, extensively referenced clinical texts which serve to document current scientific evidence and expert clinical opinion for the investigation and management of common diseases, the results of which are widely disseminated across the medical community of the UK. The Series entered its 13th successful annual cycle in January 2010.He is Director and Editor-in-Chief of the UK Masterclasses in Effective Clinical Practice Series in collaboration with the medical Royal Colleges and specialist clinical societies which examines how ‘general research evidence’ derived from the clinical literature is successfully applied to the care of difficult individual patients as part of the development of UK knowledge-based clinical practice.Professor Miles is an accomplished teacher at both undergraduate and postgraduate levels in public health and social medicine, and experienced in Master’s level course development and validation, and in university committee work and higher degree supervision at Master’s degree and PhD levels.He has published extensively in his field: over 50 edited textbooks in public health sciences and health services research, together with substantial numbers of original articles in leading peer-reviewed international clinical journals. He has contributed extensively to the international evidence-based medicine debate and to the development of thinking on the nature of knowledge for clinical practice. He has provided the intellectual leadership and organisational skills for 89 national clinical conferences and 26 national clinical masterclasses from 1998 to date. He regularly lectures at national and international conferences, and has made a substantial contribution to British medical education and clinical scholarship.


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