Models in the balance: evidence‐based medicine <i>versus</i> evidence‐informed individualized care

Miles, Andrew; Loughlin, Michael

doi:10.1111/j.1365-2753.2011.01713.x

Cited by 92 publications

(106 citation statements)

References 75 publications

(77 reference statements)

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“…Medicine has been a science-using and compassionate practice [4,[48][49][50]. Literally, physician performance may only be reliably evaluated from a sociotechnical perspective.…”

Section: Resultsmentioning

confidence: 99%

“…Perhaps, more research efforts may be put forth into developing schemes that remunerate physicians based on intrinsic-extrinsic incentives (see [51,52], for example). This research direction may contribute to policymaking for coalescing evidence-based medical practice with humanism to care for patients as whole persons as part of the development of person-centered medicine [4,[48][49][50]. It may also contribute to building a trusting relationship between healthcare managers and physicians through a better understanding of medical practice.…”

Section: Resultsmentioning

confidence: 99%

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Health information technology use and the decisions of altruistic physicians

Tsang¹

2013

EJPCH

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Rationale, aims and objectives: Knowledge is the basis and mediator of medical care. Health information technology (HIT) can help in improving care only if physicians faithfully apply their knowledge during its use. A measure of judicious HIT use has recently been proposed. Behavioural research and the oft-cited technology acceptance model suggest that beliefs/perceptions may also represent decision factors. This paper proposes a perception scale and an alternative measure of judicious HIT use. Methods: Statistical analyses were performed on a subset of survey data collected for developing an eHealth success model. This paper focuses on deriving a structural equation model that can explain the associations among intent to use HIT, professional concerns and perceptions about the impacts of HIT on care benefits. Results:The statistical results show that altruism, autonomy, the physician-patient relationship, (subconscious) autonomy, efficiency and efficacy significantly associate with each other to different extents. Only altruism and efficacy appear to be significant determinants of intent to use at p<0.01 and p<0.05, respectively. The scaled 2 difference test shows that this model is not significantly different from Tsang's model. Conclusion: Physician performance cannot be reliably evaluated and monitored when based purely on direct observations. The statistical results indicate that professional concerns associate with physicians' perceptions about the impacts of HIT and influence intent to use HIT. This paper shows a tendency of physicians to internalise factors that cannot be directly observed in the evaluation of HIT use. The study is advanced as of use in deriving policies that aim at coalescing evidencebased medical practice with humanism and thus as a significant contribution to the advancement of person-centered healthcare.

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“…Medicine has been a science-using and compassionate practice [4,[48][49][50]. Literally, physician performance may only be reliably evaluated from a sociotechnical perspective.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Health information technology use and the decisions of altruistic physicians

Tsang¹

2013

EJPCH

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“…However, evidence-based medicine has its limitations and possible stumbling blocks (Driever, 2002;Saarni et al, 2004;Miles et al, 2008;Shahar, 2008;Miles et al, 2011), in particular when it concerns diseases as complex as CF for which numerous therapeutic modalities have simply not yet been adequately studied (Cheng et al, 2000;David, 2001;Briggs et al, 2006;Kraynack et al, 2009). Best practice remains individualized in part, although a coherent foundation of evidence-based medicine is absolutely necessary.…”

Section: Marked Differences In Clinical Results Between Cf Centres: Why?mentioning

confidence: 99%

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

Lebecque¹

2012

Cystic Fibrosis - Renewed Hopes Through Research

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“…The PCM movement has, however, elected to employ the prefix 'person-centered', not for reasons of sensationalism or hubris (as characterised the inception and promotion of EBM) [41][42][43][44][45][62][63][64] , but rather as a simple mechanism to remind medicine of its epicentre -the person of the patient -at a time when the centrality of the patient within healthcare has become displaced or ignored. As Miles and Loughlin 78 (1) a wide, biological, psychological, socio-cultural and spiritual theoretical framework; (2) an approach which attends to both ill health and positive health; (3) a system which advocates person-centered research and education on the process and outcome of the patient-family-clinician communication, diagnosis as shared understanding, and treatment, prevention and health promotion as shared commitments; (4) a model of respect for the autonomy, responsibility and dignity of every person involved in the care process and (5) a philosophy of partnerships at all levels. 111,112 The fundamental need for contextualization, cross-sectionally and longitudinally, is fully in accordance with the philosopher Ortega y Gasset's dictum: 'I am I and my circumstance'.…”

Section: Person-centered Medicine Basic Principlesmentioning

confidence: 99%

“…Not that EBM and cost-containment are normative bedfellows. On the contrary, and as Miles and Loughlin 78 have pointed out, EBM is as a model of practice a 'two-edged sword' for healthcare policymakers, fully capable of greatly increasing healthcare costs as well as reducing them as a function of its identification, through its own rules, of what 'works' ('evidence') in clinical practice and what does not.…”

Section: Patient-centered Care (Pcc)mentioning

confidence: 99%

Science, Humanism, Judgement, Ethics: Person-Centered Medicine as an Emergent Model of Modern Clinical Practice / Наука, Гуманизм, Преценка, Этика, Пациент. Гуманизм В Медицина - Новая Модель В Современн Ой Клинической Практике

Miles¹

2013

Folia Medica

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The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patientcentered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies -person-centered healthcare (PCH) -are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities in addition to his/her physical needs. MUP, in assimilating such arguments and introducing person-centered medicine teaching into the University, is engaged in a notable and laudable initiative which will function as a salutary example to other medical schools within Europe and elsewhere.

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Models in the balance: evidence‐based medicine versus evidence‐informed individualized care

Cited by 92 publications

References 75 publications

Health information technology use and the decisions of altruistic physicians

Health information technology use and the decisions of altruistic physicians

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

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