The Patient-Centered Medicine as the Theoretical Framework for Patient Engagement

The Patient-Centered Medicine as the Theoretical Framework for Patient Engagement

Borghi Lidia (University of Milan, Italy), Galli Federica (University of Milan, Italy) and Vegni Elena Anna Maria (University of Milan, Italy)
DOI: 10.4018/978-1-4666-9992-2.ch002
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Abstract

The present contribution will describe the origin, development and main characteristics of the patient-centered medicine; the literature on patient-centeredness, in particular in the field of chronic disorders, will be discussed and the importance of this approach underlined; arguments about the importance of patient-centered medicine as theoretical frame founding and supporting the concept of patient engagement will be highlighted, considering that only within this medical epistemology the patient's engagement can find a full and complete expression.
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Background

Patient centered medicine is above all a revolution in medicine, a method that changes the way of practicing medicine, the way in which physicians communicate and relate with their patients during medical consultations and the role that these two actors play within the visit. It originated and spread from North America and northern Europe during the 1970s.

This way of relating to a patient has its roots on the theoretical thinking of two British psychoanalysts Michael Balint and his wife Edin, who coined the term “patient-centered medicine” in 1969. Balint (1969) wrote “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. The illness which can be described in terms of a 'traditional diagnosis' is either an incident like a broken leg, or a part like accident proneness which makes better sense if understood in terms of the whole” (Balint, 1969).

Balint, as a psychoanalyst, described a form of psycho-therapeutic intervention that general practitioners could use for people who had disorders that were partially or wholly psychosomatic; but the revolution in her thoughts and words went beyond: a new way of understanding the complaints reported by the patients, not in terms of pathology, but in terms of the unique individuality of the patient was described (Balint, 1957). In this sense, the new concept contrasted with the “doctor-centered care”, by allowing patients more control of the medical visit, and from “disease-centered care”, by focusing not only on the disease but also on the patient who suffers (Bensing, 2000).

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