Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications. Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes. Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description. Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future.
{"title":"The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol","authors":"Veena Manja, J. Wiedeman, J. Hoch, D. Farmer","doi":"10.5750/ejpch.v8i3.1793","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1793","url":null,"abstract":"Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications. Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes. Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description. Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"6 1","pages":"301-307"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82520628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article, I argue that a person-centered approach in psychiatry needs to pay attention to how mental illnesses are historically constituted and products of biological, social, psychological and cultural factors. Even if the ambition of the biopsychosocial model and the medical network model was to break with reductionist understandings of (mental) illness, I argue that these models risk stabilising, rather than deconstructing dichotomies between nature versus culture, brain versus mind, somatic versus mental or hard facts versus soft sciences. I rather propose to re-orient psychiatry as a form of “relational medicine” in which causes and reasons are treated as inseparable and where matter and meaning are entangled. A person-centered approach in psychiatry must start with the person including the embodied production of meaning in Society.
{"title":"Meaning and Matter in Psychiatry: A Historical View and New Approach","authors":"K. Slagstad","doi":"10.5750/ejpch.v8i3.1866","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1866","url":null,"abstract":"In this article, I argue that a person-centered approach in psychiatry needs to pay attention to how mental illnesses are historically constituted and products of biological, social, psychological and cultural factors. Even if the ambition of the biopsychosocial model and the medical network model was to break with reductionist understandings of (mental) illness, I argue that these models risk stabilising, rather than deconstructing dichotomies between nature versus culture, brain versus mind, somatic versus mental or hard facts versus soft sciences. I rather propose to re-orient psychiatry as a form of “relational medicine” in which causes and reasons are treated as inseparable and where matter and meaning are entangled. A person-centered approach in psychiatry must start with the person including the embodied production of meaning in Society.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"6 1","pages":"376-384"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88880241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"there cannot be treatment without judgement","authors":"J. Pheby","doi":"10.5750/ejpch.v8i3.1889","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1889","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"3 1","pages":"415-417"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85360452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.
{"title":"Disease specificity and evidence-based medicine: a historical perspective","authors":"T. Bolt, F. Huisman","doi":"10.5750/ejpch.v8i3.1795","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1795","url":null,"abstract":"This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"1 1","pages":"308-314"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89802711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one’s own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.
{"title":"Psychiatry, power and the person","authors":"Juliette Brown","doi":"10.5750/ejpch.v8i3.1865","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1865","url":null,"abstract":"Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one’s own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"15 1","pages":"363-375"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88920439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical Commentary on Pheby, J. (2020). there is nothing wrong with you. EJPCH 8 (3) 410-412","authors":"D. Pheby","doi":"10.5750/ejpch.v8i3.1888","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1888","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"150 1","pages":"413-414"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85611666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"disembodied","authors":"J. Pheby","doi":"10.5750/ejpch.v8i3.1891","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1891","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81772574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH.
{"title":"The ethical and epistemic roles of narrative in person-centred healthcare","authors":"M. Walker, W. Rogers, V. Entwistle","doi":"10.5750/ejpch.v8i3.1863","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1863","url":null,"abstract":"Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73175511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.
{"title":"Persons over models: shared decision-making for person-centered medicine","authors":"M. Annoni, C. Blease","doi":"10.5750/ejpch.v8i3.1864","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1864","url":null,"abstract":"In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"73 1","pages":"355-362"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75264475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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