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

Main Article Content

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.

Article Details

Section
Editorial
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.

References

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

Miles, A. & Mezzich, J.E. (2012). Person-centered medicine: addressing chronic illness and promoting future health. International Journal of Person Centered Medicine 2 (2) 149-152.

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

patient-centered care ref.

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.

United Nations. (2011). High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 66th Session of the General Assembly. New York: 19 & 20 September 2011. http://www.un.org/en/ga/ncdmeeting2011/

McWhinney, I.R. (1978). Medical knowledge and the rise of technology. Journal of Medicine and Philosophy 3, 273-304.

Harding, S. (1978). Knowledge, technology and social relations. Journal of Medicine and Philosophy 3, 346-358.

Leder, D. (1992). Introduction. In: The Body in Medical Thought and Practice. Ed. Leder, D., pp. 1-16. Dordrecht: Kluwer Academic Press.

Savodnik, I. (1978). Psychosomatic medicine. Journal of Medicine and Philosophy 3, 331-345.

Reiser, S.J. (1978). Medicine and the reign of technology. New York: Cambridge University Press.

Reiser, S.J. (1978). The decline of clinical dialogue. Journal of Medicine and Philosophy 3, 305-313.

Miles, A. (2012). Person-centered medicine – at the intersection of science, ethics and humanism. International Journal of Person Centered Medicine 2 (3) 329-333.

Foucault, M. (1994). The Birth of the Clinic. New York: Vintage Books.

Zaner, R.M. (1988). Ethics and the clinical encounter. Englewood Cliffs NJ: Prentice Hall.

Toombs, S.K. (1988). Illness and the paradigm of the lived body. Theoretical Medicine 9, 201-226.

Toombs, S.K. (1990). The temporality of illness: four levels of experience. Theoretical Medicine 11, 227-241.

Toombs, S.K. (1993). The meaning of illness: a phenomenological account of the different perspectives of physician and patient. Dordrecht: Kluwer Academic Publishers.

Toombs, S.K. (1995). The lived experience of disability. Human Studies 18, 9-23.

Toombs, S.K. (1995). Chronic illness and the goals of medicine. Second Opinion 21, 11-19.

Toombs, S.K., Barnard, D. & Carson, R.A. (1995). Chronic illness: from experience to policy. Bloomington: Indiana University Press.

Toombs, S.K. (2001). Handbook of Phenomenology and Medicine. Dordrecht: Kluwer Academic Publishers.

Toombs, S.K. (2002). Persons and their bodies: rights, responsibilities, relationships. Philosophy and Medicine 60, 73-94.

Frankl, Viktor: quoted by Arthur Koestler, Beyond Reductionism, Hutchinson, London, 1969.

Habermas. Future of human nature.

Heidegger. Basic writings.

Nunn, R. (2008). Evidence-based medicine and the limits to the literature search. Journal of Evaluation in Clinical Practice 14, 672-678.

Miles, A. (2008). Evidence for practice and the authority of experts: there can be no former without the latter. Journal of Evaluation in Clinical Practice 14, 679-681.

Miles, A. (2012). Science, humanism, judgement, ethics. Journal of Evaluation in Clinical Practice In Press.

Charles, C., Gafni, A. & Freeman, E. (2011). The evidence-based medicine model of clinical practice: scientific teaching or belief-based preaching? Journal of Evaluation in Clinical Practice 17, 597-605.

Guyatt, G.H., Cook, D. & Haynes, R.B. (2004). Evidence-based medicine has come a long way. British Medical Journal 329, 990-991.

Djulbegovik, B., Guyatt, G.H. & Ashcroft, R.E. (2009). Epistemologic enquiries in evidence-based medicine. Cancer Control 16, 158-168.

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

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 medicine. Journal of Evaluation in Clinical Practice 15, 941-949.

Goldenberg, M. (2006). On evidence and evidence-based medicine: lessons from the philosophy of science. Social Science and Medicine 62, 2621-2632

Goldenberg, M. (2009). Iconoclast or creed? Objectivism, pragmatism and the hierarchy of evidence. Perspectives in Biology and Medicine 52, 168-187

Goldenberg, M. (2010). Clinical evidence and the absent body in medical phenomenology: on the need for a new phenomenology of medicine. International Journal of Feminist Approaches to Bioethics 3, 43-71.

Henry, S.G., Zaner, R.M. & Dittus, R.S. (2007). Moving beyond evidence-based medicine. Academic Medicine 82, 292-297

Henry, S.G. (2010). Polanyi’s tacit knowing and the relevance of epistemology to clinical medicine. Journal of Evaluation in Clinical Practice 16, 292-297.

Lacy, N.M. & Backer, E.L. (2008). Evidence-based and patient-centered care: results from an STFM group project. Family Medicine Journal 40, 417–422.

Baumann, M.H., Lewis, S.Z. & Gutterman, D. (2007). ACCP evidence-based guideline development: a successful and transparent approach addressing conflict of interest, funding and patient-centered communications. Chest 132, 1015-1024.

Borgmeyer, C. (2005). AAFP’s commitment to evidence-based, patient-centered care. Annals of Family Medicine 3, 378-380.

Krahn, M. & Naglie, G. (2008). The next step in guideline development: incorporating patient preferences. Journal of the American Medical Association 300, 436-439.

Miles, A. & Mezzich, J. E. (2011). The patient, the illness, the doctor, the decision: negotiating a ‘new way’ through person-centered medicine. International Journal of Person Centered Medicine 1, 637-640.

http://www.youtube.com/playlist?list=PLB0B1B5EA747F2771

http://www.pchealthcare.org.uk/home

Miles, A. (2012). Person-centered medicine: at the intersection of science, ethics and humanism. International Journal of Person Centered Medicine 2 (3) 329-333.

Pellegrino, E. D. (1979). The most humane of the sciences, the most scientific of the humanities. In: Humanism and the Physician. Ed. Pellegrino, E.D., pp 4-14. Knoxville: University of Tennessee Press.

Englehardt, Jr. H. T. & Jotterand, F. (Eds.) (2008). The Philosophy of Medicine Reborn: A Pellegrino Reader. Indiana: University of Notre Dame Press.