Person-centred medicine: towards a definition.

The history of the relationship between Complementary and Alternative Medicine (CAM) and mainstream health care has shifted from the early days of pluralism, through hostility and exclusion, to one of grudging acceptance. The current situation is characterised by a tacit acknowledgement and in some cases opens endorsement by biomedicine for a number of forms of CAM practice, largely driven by the popularity of CAM to consumers in our increasingly market-driven health care system both on the practice of CAM and biomedicine, and on the health care choices available to consumers [1]. Person-centred medicine lies at the interface of biomedicine and traditional, complementary and alternative medicine (TM/CAM) or non-conventional medicine (NCM). Concepts like health care strictly connected with that of health genesis are introduced together with data concerning CAM/NCM in the Western world [2]. The term ‘person-centred medicine’ in terms of sustainability clearly includes the sense of NCM/ CAM as a synergistic and harmonious blend of conventional and complementary medicine, but looks open to future developments. The results of numerous surveys on health care quality carried out in the USA and in Europe show that, if a patient is asked to assess the quality of the medical treatments, his/her priorities are: humanization, tailoring of the treatments, the need of attention from public institutions and adequate information in a comfortable environment for a free choice of the individual health programme. However, despite WHO’s definition of health, the attitudes and practice of much of modern medicine have become profoundly disease focused and organ specific with ever increasing specialization. The limitations of disease-specific approaches in the context of the growing prevalence of co-morbidity are becoming more obvious. Humanistic behaviour is considered an essential component of professional medical care. However, the evidence shows that it is often neglected. Many barriers to the expression of sensitivity to the patient’s concerns, empathy, and compassion in the clinical encounter can be identified. Time constraints, poor continuity of care, appearance of alienating factors between patients and physicians, and the ‘hidden curriculum’ are just a few in a long list [3]. Person-centred medicine is a humanistic and at the same time evidence-based approach. For all human beings the essence of diagnosis and therapy is that they be tailored to the intrinsic unity of man’s physical and mental nature. This is fundamental to the healing process. Person-centred medicine allows for that individual psycho-physical equilibrium which is, and will be, the basis for any sustainable equilibrium in society at present or in the future. Person-centred medicine calls for wider medical knowledge and practice, not only of how to treat pathology but how to generate health (health-genesis). It is a systemic approach, not mechanistic or reductive. It typically adopts a unitary view of sentient being and the world; it values the complexity of natural phenomena; it studies the relations of man to his environment, how body and psyche interact, what spiritual integrity means in a human being; and stresses active patient responsibility for keeping healthy or being healed. In the middle of the doctor-patient relationship under this person-centred approach lies the patient’s own ‘narration’. This narration is part and parcel of how the patient ‘makes sense’ across the spectrum of his/her bio-psycho-spiritual existence. Person-centred medicine entails total a priori acknowledgement of and respect for each individual’s dignity – hence physical, psychological, and spiritual suffering. Person-centred medicine at this point becomes anthropological medicine. The development of appropriate and effective therapeutic strategies entails a negotiated understanding between the culture of biomedicine, within which health care providers work, and the patient’s cultural experience of illness. At a time of increasing emphasis on regulating health care and restraining expenditures, this person-centred approach would better equip patients to make informed decisions. For discretionary tests and procedures, complete information about expected benefits and risks may lead many individuals to choose alternative strategies or to be more confident in the