Why P6 Medicine Needs Clinical Psychology and a Trans-Cultural Approach.

In the last decades, medicine has undergone profound and deep changes and challenges, such as the introduction of new medical devices and nanobiotechnologies,1-3 that have enabled the understanding of molecular pathogenesis at unprecedented levels. Nanogenomics and nanoproteomics represent the frontiers of biomedicine,4-7 paving the way for a personalized diagnosis and treatment, that is to say not just a one-size-fits-it-all therapy as before but a tailored, targeted therapeutics. There has been a shift from P0 medicine to a P6 model (where the six Ps stay for preventive, predictive, personalized, participatory, public and psycho-cognitive medicine).8 However, the introduction of new bio-techniques and procedures with their ethical implications as well as the emerging paradigm of a proactive medicine, focusing not only on acute diseases but above all on chronic pathologies, make psychology a not negligible and secondary component of this highly integrative approach. A patient is not only a disease, a clinical case or a genetic and biological entity but, first of all, a person and for a real personalized treatment a holistic integrated bio-psychosocial approach should be carried out.9-11 A good clinical practice should focus on the patientrecorded outcomes and measurements (PROMs), such as quality of life, customer satisfaction of the health-care process, if really wants to transform itself in a person-related and patient-centered medicine (as Carl Rogers and Michael Balint advocated). This would overcome paternalism and asymmetry in the physician-patient relationship and involving and empowering the patient and taking shared clinical decisions would result in a better health outcome. Understanding the behavioral and cognitive aspects of the patient’s decisions and preferences is fundamental and vital, considering that nowadays therapies are more complex being combination of drugs and that patient’s adherence and compliance can have an impact on the success or failure of the treatment. Moreover, a culturally competent perspective should inform clinician’s approach in a globalized era,12,13 considering that immigrants are more likely to suffer from mental health problems and psycho-social issues.14-17 For these reasons, psychology and a transcultural informed approach are an important component of the nowadays emerging P6 medicine.