Open Access Open Access  Restricted Access Subscription or Fee Access

Mapping similarities and differences to progress mutual understanding and dialogue: A comparison and contrast of evidence-based practice and person-centered healthcare

James Marcum

Abstract


Evidence-based practice and person-centered healthcare are often seen as opposing approaches to clinical practice. And yet both offer advantages to providing quality healthcare. In this paper, both approaches to clinical practice are analyzed and mapped philosophically by comparing and contrasting their key foundational principles. The goal is to progress the dialogue between them in order to determine whether a common ground exists in which they might be integrated and how best to operationalize, both clinically and pedagogically, an integrated approach. To that end, key principles undergirding them are enumerated and then integrated by shifting the focus from evidence to the person - whether patient or clinician - for the delivery of quality healthcare. In this way, person-centered healthcare provides the optimal starting point for framing evidence-based practice. Next, operationalizing the integrated approach to clinical practice and medical education is addressed. Finally, the root of modern healthcare must be a person’s, whether patient’s or clinician’s, dignity. For the goal of healthcare is to relieve suffering associated with illness, whether that involves curing a disease or not and not adding to the suffering associated with illness.

Keywords


Caring, clinical encounter, clinical practice, dignity, evidence-based practice, GRADE, integration, person-centered healthcare, personhood, philosophical basis, preferences, quality healthcare, suffering, values

Full Text:

PDF

References


Straus, S.E. & McAlister, F.A. (2000). Evidence-based medicine: a commentary on common criticisms. Canadian Medical Association Journal 163 (7) 837-841.

Berwick, D.M. (2009). What ‘patient-centered’ should mean: confessions of an extremist. Health Affairs 28 (4) w555-w565.

Bensing, J. (2000). Bridging the gap: the separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling 39 (1) 17-25.

Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. Journal of the American Medical Association 268 (17) 2420-2425.

Timmermans, S. & Mauck, A. (2005). The promises and pitfalls of evidence-based medicine. Health Affairs 24 (1) 18-28.

Tonelli, M.R. (2001). The limits of evidence-based medicine. Respiratory Care 46 (12) 1435-1440.

Sackett, D.L., Rosenberg, W.M., Gray, J.M., Haynes, R.B. & Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal 312 (7023) 71-72.

Straus, S.E., Glasziou, P., Richardson, W.S. & Haynes, R.B. (2011). Evidence-based medicine: how to practice and teach it, 4th edn. Edinburgh: Elsevier Churchill Livingstone.

Guyatt, G.H., Oxman, A.D., Schünemann, H.J., Tugwell, P. & Knottnerus, A. (2011). GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology 64 (4) 380-382.

Goldet, G. & Howick, J. (2013). Understanding GRADE: an introduction. Journal of Evidence-Based Medicine 6 (1) 50-54.

Kelly, M.P., Heath, I., Howick, J. & Greenhalgh, T. (2015). The importance of values in evidence-based medicine. BMC Medical Ethics 16 (1) 69.

Djulbegovic, B. & Guyatt, G.H. (2017). Progress in evidence-based medicine: a quarter century on. Lancet 390 (10092) 415-423.

Greenhalgh, T., Howick, J. & Maskrey, N. (2014). Evidence-based medicine: a movement in crisis? British Medical Journal 348, g3725.

Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: Person-centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Marcum, J.A. (2015). Healthcare personalism: a prolegomenon. European Journal for Person Centered Healthcare 3 (2) 228-232.

Loughlin, M. (2014). What person-centered medicine is and isn’t: temptation for the ‘soul’ of PCM. European Journal for Person Centered Healthcare 2 (1) 16-21.

Marcum, J.A. (2008). An Introductory Philosophy of Medicine: Humanizing Modern Medicine. New York: Springer.

Post, P.N. & Guyatt, G.H. (2014). Evidence-based medicine offers an optimal starting point for person-centered medicine. European Journal for Person Centered Healthcare 2 (1) 76-78.

Smith, C. (2011). What is a Person? Rethinking Humanity, Social Life, and the Moral Good from the Person Up. Chicago: University of Chicago Press.

Cassell, E.J. (2004). The Nature of Suffering and the Goals of Medicine, 2nd edn. New York: Oxford University Press.

Berghmans, R. & Schouten, H.C. (2011). Sir Karl Popper, swans, and the general practitioner. British Medical Journal 343, d5469.

Ioannidis, J.P.A. (2016). Evidence-based medicine has been hijacked: a report to David Sackett. Journal of Clinical Epidemiology 73, 82-86.

Miles, A. & Asbridge, J.E. (2017). Person-Centered Healthcare - moving from rhetoric to methods, through implementation to outcomes. European Journal for Person Centered Healthcare 5 (1) 1-9.

Whelton, P.K., Carey, R.M., Aronow, W.S. et al. (2017). 2017 ACC / AHA / AAPA / ABC / ACPM / AGS / AphA / ASH / ASPC / NMA / PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71 (6) e13-e115.

Pellegrino, E.D. & Thomasma, D.C. (1993). The Virtues in Medical Practice. New York: Oxford University.

Marcum, J.A. (2012). The Virtuous Physician: The Role of Virtue in Medicine. New York: Springer.

Shah, N. & Marcum, J.A. (2015). Can virtues be taught in medicine? Aristotle’s virtue theory and medical education and clinical practice. Mirabilia Medicinae 4 (1) 9-21.

Weissmann, P.F., Branch, W.T., Gracey, C.F., Haidet, P. & Frankel, R.M. (2006). Role modeling humanistic behavior: learning bedside manner from the experts. Academic Medicine 81 (7) 661-667.

Chuang, A.W., Nuthalapaty, F.S., Casey, P.M., Kaczmarczyk, J.M., Cullimore, A.J., Dalrymple, J.L., Dugoff, L., Espey, E.L., Hammond, M.M., Hueppchen, N.A., Katz, N.T., Peskin, E.G., Undergraduate Medical Education Community & Association of Professors of Gynecology and Obstetrics. (2010). To the point: Reviews in medical education - Taking control of the hidden curriculum. American Journal of Obstetrics & Gynecology 203, 316.e1-6.

Marcum, J.A. (2013). The role of empathy and wisdom in medical practice and pedagogy: confronting the hidden curriculum. Journal of Biomedical Education doi:10.1155/2013/923810.

Marcum, J.A. (2016). Healthcare personalism and the nature of the person. How can personalist thought advance the conceptual basis of person-centered medicine? European Journal for Person Centered Healthcare 4 (2) 409-416.




DOI: http://dx.doi.org/10.5750/ejpch.v6i3.1496

Refbacks

  • There are currently no refbacks.