1406-CD1.1: Defining and disambiguating patient-centredness
Today, we are coming to recognise that patient-centredness is fundamental to the nature of medicine. It was integral to medical practice prior to the scientific era, but its loss began in the move towards technical practice that started in the 17th century and the professionalisation of the social roles of physician and surgeon in the 18th century onwards. A century later, its loss became evident and it began to emerge again (Putnam, 1899), boosted by the development of nursing but struggling to cope with reductionist approaches in science and the rapid development of technology. In the latter half of the 20th century, with an expansion of identity-politics, patient-centredness was rediscovered as an equally essential aspect of medicine rather than as an alternative to quasi-scientific medical practice. What is patient-centredness, what is it not, and what is its potential? Our conclusions in this paper are based on a critical review of much of the literature on patient-centredness, of which the appended Bibliography forms a small sample with some key references.
Reviewing these sources, it becomes clear that the literature on patient-centredness itself rarely uses a patient-centred perspective and that, in practice, patient-centredness continues to be defined largely in physicians’ terms and framed by the characteristics of national, professional, or financial systems: for example, the (American) Institute of Medicine’s 2001 report is a review limited to commercial approaches within a physician-centred model of medicine. Similar problems are evident with reports from the UK’s King’s Fund. These current approaches presuppose that the definition of patient-centredness changes according to the system in which it is expressed. This is itself a key problem, as the system defines and interprets patients’ needs according to the systems’ own needs first. It is only within the past few years that patient-centredness has started to be defined purely in terms of the patient’s needs and from the patient’s perspective, independent of any given system and unfiltered by any profession. This is the approach that we take in this discussion-paper.
At the Tuke Institute, we believe that the needs of all of us as patients must be the starting point of any definition and interpretation of what patient-centredness is, regardless of the expression it may find in any given system. It is on this basis that we have developed and disambiguated the concept as follows and we believe that—in the best tradition of scientific knowledge—the necessary methods of operationalisation of those principles should emerge from the principles themselves.
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