A Better Grounding for Person-Centered Medicine?

Abstract

There is nothing like medicine to attract reformers. Their arguments include claims that orthodox medicine produces iatrogenic harm, it is too expensive, it is arrogantly exclusive of other systems of practice, its practitioners lack empathy and communication skills, and its practitioners are wilfully ignorant of their patients’ beliefs and needs. Entwistle and Watt (2013) have done a good job of gathering together the suggested modes of reform from the last 50 years or so. They might well have gone back to Peabody (1927) and Osler (1948), and beyond to Colles (1881) and even to the Salerno school of the 11th century, because there is a long history of people and movements that have sought to make medicine more humanistic, more considerate, better behaved. There is an equally long history of criticism of the medical profession for its materialism, cynicism, and capacity for self-serving. All such criticisms deserve careful attention, and the profession's modern response has been to introduce processes that can be seen to deal with specific shortcomings. Yet the reform movements still proliferate—humane medicine, patient-centered care, narrative-based medicine, empathic care, mindful practice, values-based medicine, and most recently—and perhaps significantly—person-centered medicine (Ekman et al. 2012; Henry, Zaner, and Dittus 2007; Miles and Mezzich 2011a; Miles and Mezzich 2011b). The latter has become an umbrella term for Entwistle and Watt to cover all the qualitative reform movements that remain alive, if not flourishing. In doing this, they do us a service by reminding us of the common ground that these movements share. It should also remind us—although the article avoids dwelling on the matter— that all the current schemes are offered as alternatives to the immense influence of evidence-based medicine (EBM)