The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice

Miles, Andrew; Mezzich, Juan E.

doi:10.5750/ijpcm.v1i2.61

Cited by 121 publications

(175 citation statements)

References 101 publications

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“…Internet-based mental health (MH) education and services are on the rise, as more patients, caregivers, and MH providers are using the Internet. This is driven by consumers or persons at-large, before they become patients in traditional services, and transitions our thinking from clinic-based care past patient-centered care to person-centered care known as participatory medicine [19][20][21]. MH-related, technology-based services exist on a continuum: self-help/support groups -well-prepared materials for patient psychoeducation and provider professional education -tips for assessment and selfcare (e.g., depression) -informal provider consultation online -asynchronous communication with providers -MH services with professionals like teleMH ((TMH) care or; Internet-based cognitive behavioral treatment (CBT) [22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

New Frontiers in Healthcare and Technology: Internet-and Web-Based Mental Options Emerge to Complement In-Person and Telepsychiatric Care Options

Hilty¹,

Chan²,

Torous³

et al. 2015

J Health Med Informat

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Background: Web and Internet-based resources are remarkably popular with the public, patients and others as a way to access mental health information, tools for self-care, advice/consultation from a professional, and providerdirected treatments.Objective: This paper provides a framework of a spectrum that includes person-centered health education options (conceptual endpoint), patient and caregiver-centered mental health care interventions (evidence-based literature review), and more formal provider-directed treatments (conceptual endpoint). Methods:The evidence-based literature review was focused on treatment studies, using a minimum of three key words and the 1996-2015 period, resulting in 13,612 articles. This was reduced to 388 (title words used), to 125 (abstracts for methods, design, and outcomes) and 40 (evidence-based criteria of guidelines). Results:Technology is frequently used, is readily accessible and satisfies persons, patients, and caregivers. Its impact on openness to engage with others and begin self-care appears very positive; its ability to help people change behaviors and engage additional clinical services appears modest, though this is inadequately evaluated. Formal treatments over the Internet, asynchronous care models, or traditional video-based synchronous services are as good as or better than in-person services, though an incomplete range of services has been evaluated. Relatively few treatment studies assess outcomes, compare in-person and e-MentalHealth care, and or compare technology-based care options to one another; hybrid models of care have emerged, but have rarely been studied. Conclusions:For persons or patients not in care, use of the internet for common, non-acute problems appears to work, though a one-time clinical evaluation may help them place options in context. Clinicians and patients should specifically plan how to use technology and exercise sound judgment, based on guidelines when available. More research is needed on the application of new technologies to clinical care, with randomized trials and health services studies for effectiveness suggested. Internet-based mental health (MH) education and services are on the rise, as more patients, caregivers, and MH providers are using the Internet. This is driven by consumers or persons at-large, before they become patients in traditional services, and transitions our thinking from clinic-based care past patient-centered care to person-centered care known as participatory medicine [19][20][21]. MH-related, technology-based services exist on a continuum: self-help/support groups -well-prepared materials for patient psychoeducation and provider professional education -tips for assessment and selfcare (e.g., depression) -informal provider consultation online -asynchronous communication with providers -MH services with professionals like teleMH ((TMH) care or; Internet-based cognitive behavioral treatment (CBT) [22][23][24][25][26][27][28][29][30]. New Frontiers in Healthcare andConsumers, patients, caregivers and provi...

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Section: Discussionmentioning

confidence: 99%

New Frontiers in Healthcare and Technology: Internet-and Web-Based Mental Options Emerge to Complement In-Person and Telepsychiatric Care Options

Hilty¹,

Chan²,

Torous³

et al. 2015

J Health Med Informat

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“…Engel's sentinel contribution was, then, not intended to cause some form of paradigmatic change in medicine, but rather to broaden the scope of the clinician's 'gaze', arguing for an understanding of the patient as a person and a way of 'thinking' and 'doing' in clinical practice that formally rejected the development of a cold, impersonal, technical, biomedically-dominated style of clinical practice which either ignored -or rejected -the human dimension of suffering. 3,4,9,10 …”

Section: Historical Perspectives On the Rise Of Scientific Medicine Amentioning

confidence: 99%

“…12 The equation of medicine as science, rather than to understand medicine properly as a science-using practice has, it is asserted, directly precipitated the depersonalisation of clinical practice into the reductive model that is visible today. [1][2][3][4][11][12][13] In my view, the representation of medicine as science is in reality a frank misrepresentation of medicine, but one in which the majority of doctors now collude.…”

Section: The Nature Of Medicinementioning

confidence: 99%

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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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“…17 In order to understand social media, we need to understand the person behind the patient, and why/how they do what they do. [18][19] In healthcare and particularly psychiatry, "quality" care typically depends on patient-doctor engagement, the therapeutic relationship, and shared decision-making for treatment. 20 A bio-psycho-socio-cultural (BPSC) model of care has been suggested, 21 as we explore beliefs, norms, and values, and ethnic, culture and language issues that affect health.…”

Section: Technology Entry Into Clinical Carementioning

confidence: 99%

Technology and the Brain: Lessons from Patient Care, Social Media and the Internet

Hilty¹

2017

Psychol Cogn Sci Open J

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OVERVIEWTechnology is sweeping through our society in unparalleled fashion, affecting our day-to-day life, education, social relationships, healthcare and business. Our human experience and neuroscience both determine how we interface with technology such that we have "good" (i.e., enjoyment, excitement) and "bad" (i.e., stress) experiences. With regard to healthcare, the patient-centered era features quality, affordable, and timely care; technology is a key part of that, particularly among younger generations. Indeed, the consumer movement related to new technologies may be passing some clinicians by, as new ways of communicating with others (text, e-mail, Twitter, Facebook, social media). More reflection is needed on how technology "changes" us, may become the focus of our worst attributes and causes significant problems (e.g., pathological Internet use, privacy/confidentiality breeches). Research approaches and frameworks are needed across many fields and disciplines of science, medicine and human behavior regarding our use of technology. HUMAN NATURE AND HOW WE LEARNA recent article distinguishes our species-homo sapien-by our ability to contemplate the future through cortical function; 1 homo prospectus is suggested since we thrive by considering our prospects and this foresight created civilization and sustains society. When making plans, we have higher levels of happiness and lower levels of stress than at other times, perhaps because this channels concerns into an organized plan. Studies show depressed people imagine fewer positive scenarios while overestimating future risks. We are also governed by the subcortical function, too, in many ways including addictions.Cognitive psychology focuses on learning, memory and perception. Learning is a complex neurobiological and social phenomenon. How we learn is dependent on our personal experience and professional training, including what is formally taught and what we learn on our own. Discussing what we know, what we don't, and how to learn better/more is a key developmental step. Evaluating our strengths and weaknesses is also essential for professional development. Using our 'best' learning styles and facilitating others' gives us many ways to approach problems. 2-3Neurobiology informs us on learning, including Hebbian theory about adaptation of neurons in the brain during this process. Synaptic plasticity and increased synaptic efficacy arises from the presynaptic cell's repeated and persistent stimulation of the postsynaptic cell. 4 Similarly, behaviorists think of animal learning as the ingraining of habit by repetition. Injury and mental illness (e.g., schizophrenia) disrupt this. Repetition and planned redundancies help us enhance our retention by allowing us to "relearn" things as we build toward more complex skills. Visualization is another form of repetition, which may mentally 'prepare' us to perform tasks. Stress in moderation is helpful and in principle, fatigue, Multitasking and interruptions are to be minimized. Sociologic, educational and psycho...

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The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice

Cited by 121 publications

References 101 publications

New Frontiers in Healthcare and Technology: Internet-and Web-Based Mental Options Emerge to Complement In-Person and Telepsychiatric Care Options

New Frontiers in Healthcare and Technology: Internet-and Web-Based Mental Options Emerge to Complement In-Person and Telepsychiatric Care Options

Technology and the Brain: Lessons from Patient Care, Social Media and the Internet

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