Chronic Illnesses, Vulnerability, and Uncertainty: How Do Recent Challenges Impact on Patient-Centered Medicine?

Chronic Illnesses, Vulnerability, and Uncertainty: How Do Recent Challenges Impact on Patient-Centered Medicine?

Eugenia Cao di San Marco (Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Italy), Elena Vegni (Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Italy & Department of Health Sciences, University of Milan, Italy) and Lidia Borghi (University of Milan, Italy)
Copyright: © 2019 |Pages: 14
DOI: 10.4018/IJPCH.2019010104
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Abstract

The goal of this chapter is to describe some of the recent challenges that modern medicine is facing using patient-centered medicine as a theoretical frame of reference. First, the work will describe the origin, the development, and the main implications of patient-centered medicine (PCM). Then, it will address the critical increase of chronic illnesses and how PCM could be the best-suited theoretical framework for enhancing patient engagement and coping with chronicity. Additionally, it will address the difficulties raised by increased uncertainty in medical practice, especially from the physicians' point of view. Finally, a relationship-centered care (RCC) will be proposed as a more effective theoretical perspective than PCM to deal with uncertainty and its impact on the patients' and physicians' inner life.
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Background

Patient-centered medicine is, above all, a revolution in medicine, a method that changes the way of practicing medicine, how physicians relate and communicate with their patients during medical consultations, and also the roles of the other actors within the visit, such as family members and other healthcare professionals. This way of relating to a patient has its roots in the theoretical thinking of two British psychoanalysts, Michael Balint, and his wife, Edin, who coined the term “patient-centered medicine” in 1969.

There is another way of medical thinking, which we call ‘patient-centered medicine.’ Here, in addition to trying to discover a localizable illness or illnesses, the doctor also has to examine the whole person in order to form what we call an ‘overall diagnosis.’ This should include everything the doctor knows and understands about his patient; the patient, in fact, has to be understood as a unique human being (Balint, 1969).

The development of this method should be viewed in light of an epistemological change of paradigm, which shifted the science of medicine from the biomedical model to a bio-psychosocial paradigm. These changes in medical epistemology have a significant impact on the clinical method moving from a disease-centered to a patient-centered perspective. The biomedical model was based on a biological reductionist approach. That is, patients were read as the expression of disease processes and the clinical method focuses on identifying standard disease entities and numeric entities and, on this basis, proposes an evidence-based treatment. This is the reason why this paradigm is called “doctor-centered medicine” or “disease-centered medicine” (DCM). This clinical method was simple, clear, verifiable, and allowed for the formulation of diagnostic hypotheses and prognosis (McWhinney, 1989, 1993). Nevertheless, it has been criticized for oversimplifying the problems of illness; assuming that disease is fully accounted for by deviations from the norm of measurable, biological variables and not taking into account the patient’s perspective.

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