Patient non-adherence is a common and important problem in clinical medicine. Some cases of patient non-adherence are cases in which the patient disagrees with the physician’s recommended treatment based on particular reasons. In this chapter, by drawing upon the science and technology studies literature, specifically the discussion by Collins and Evans and also Wynne of how best to understand scientific controversies, I relate their ideas to the analogous conflict that may occur within a clinical encounter. I draw upon their recognition of the importance of contributory expertise and interactional expertise in providing legitimate knowledge. I also draw upon Wynne’s idea of the ‘negotiation of meanings’ as an important element of the clinical interaction. To resolve potential conflicts between patient and physician before they develop into ‘non-adherence’, I propose the need for a new epistemological framework that recognizes legitimate knowledge offered by the patient as well as the physician. By situating this patient expertise framework within the paradigm of person-centred medicine, and by assuming the goal of medical treatment to be treatment of suffering , patient expertise becomes centralized as a means of determining the nature of patient suffering. Two aspects of the patient’s tacit knowledge - the body aspect and the meaning aspect - both of which are context-dependent and directly accessible only to the patient, are thus recognized as knowledge essential to the success of the interaction. The physician’s role becomes that of both medical expert and possessor of interactional expertise, by which the physician recognizes and includes patient expertise in the treatment decision. Finally, the patient expertise framework must also involve recognizing and incorporating the ‘negotiation of meanings’ into the development of a treatment plan. By acknowledging the importance of patient expertise and the negotiation of meanings, this patient expertise framework should dissolve the problem of patient non-adherence that derives from the patient disagreeing with the therapeutic plan.
{"title":"Acknowledging Patient Expertise and the Negotiation of Meanings in the Clinical Encounter","authors":"Mary-Clair Yelovich","doi":"10.5750/ejpch.v8i3.1862","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1862","url":null,"abstract":"Patient non-adherence is a common and important problem in clinical medicine. Some cases of patient non-adherence are cases in which the patient disagrees with the physician’s recommended treatment based on particular reasons. In this chapter, by drawing upon the science and technology studies literature, specifically the discussion by Collins and Evans and also Wynne of how best to understand scientific controversies, I relate their ideas to the analogous conflict that may occur within a clinical encounter. I draw upon their recognition of the importance of contributory expertise and interactional expertise in providing legitimate knowledge. I also draw upon Wynne’s idea of the ‘negotiation of meanings’ as an important element of the clinical interaction. To resolve potential conflicts between patient and physician before they develop into ‘non-adherence’, I propose the need for a new epistemological framework that recognizes legitimate knowledge offered by the patient as well as the physician. By situating this patient expertise framework within the paradigm of person-centred medicine, and by assuming the goal of medical treatment to be treatment of suffering , patient expertise becomes centralized as a means of determining the nature of patient suffering. Two aspects of the patient’s tacit knowledge - the body aspect and the meaning aspect - both of which are context-dependent and directly accessible only to the patient, are thus recognized as knowledge essential to the success of the interaction. The physician’s role becomes that of both medical expert and possessor of interactional expertise, by which the physician recognizes and includes patient expertise in the treatment decision. Finally, the patient expertise framework must also involve recognizing and incorporating the ‘negotiation of meanings’ into the development of a treatment plan. By acknowledging the importance of patient expertise and the negotiation of meanings, this patient expertise framework should dissolve the problem of patient non-adherence that derives from the patient disagreeing with the therapeutic plan.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"8 1","pages":"336-344"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82183750","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). disembodied EJPCH 8 (3) 419-421","authors":"D. Pheby","doi":"10.5750/ejpch.v8i3.1892","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1892","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"85 1","pages":"422-423"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83887306","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). a rare ecstatic rawness EJPCH 8 (3) 406-408","authors":"D. Pheby","doi":"10.5750/ejpch.v8i3.1886","DOIUrl":"https://doi.org/10.5750/ejpch.v8i3.1886","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"16 9 1","pages":"409"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89938309","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":"to be nothing but pain","authors":"J. Pheby","doi":"10.5750/ejpch.v8i2.1857","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1857","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"1 1","pages":"270-272"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73073047","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":"MSc in Person Centred Health and Social Care","authors":"A. Williamson","doi":"10.5750/EJPCH.V8I2.1881","DOIUrl":"https://doi.org/10.5750/EJPCH.V8I2.1881","url":null,"abstract":"","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74045071","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}
J. Gabb, M. Annoni, C. Blease, H. Gerger, Cosima Locher
While there is undisputedly a great need to establish, maintain, evaluate, provide and disseminate good treatments, the consensus as to what constitutes a good treatment is far less established. Here, we deconstruct the phrase into its components, seeking to describe definitory elements of both what is to be considered a treatment and how this could be good. Thereby, we identify deliberateness in the context of an adequately empathic and humane relationship as being at the core of a good treatment. Thus, care becomes treatment when provided deliberately and treatment becomes good, when provided deliberately with care. Since this understanding encompasses biological, psychological and social treatment constituents in the context of ethical considerations, we propose a ‘biopsychosocioethical’ model for treatment as a conceptual frame, which is centred on a shared understanding of what should be achieved by the treatment and how this is achieved.
{"title":"The good treatment: a biopsychosocioethical proposition","authors":"J. Gabb, M. Annoni, C. Blease, H. Gerger, Cosima Locher","doi":"10.5750/ejpch.v8i2.1843","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1843","url":null,"abstract":"While there is undisputedly a great need to establish, maintain, evaluate, provide and disseminate good treatments, the consensus as to what constitutes a good treatment is far less established. Here, we deconstruct the phrase into its components, seeking to describe definitory elements of both what is to be considered a treatment and how this could be good. Thereby, we identify deliberateness in the context of an adequately empathic and humane relationship as being at the core of a good treatment. Thus, care becomes treatment when provided deliberately and treatment becomes good, when provided deliberately with care. Since this understanding encompasses biological, psychological and social treatment constituents in the context of ethical considerations, we propose a ‘biopsychosocioethical’ model for treatment as a conceptual frame, which is centred on a shared understanding of what should be achieved by the treatment and how this is achieved.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"102 1","pages":"201-206"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86021194","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}
a General and Vascular Surgeon, Private Practice in Oporto, Portugal b Professor of Person Centred Care & Co-Director, European Institute for Person Centred Health and Social Care, School of Biomedical Sciences, University of West London UK / Senior Vice President/Secretary General, European Society for Person Centered Healthcare & Editor-in-Chief, European Journal for Person Centered Healthcare & Founding Editor, Journal of Evaluation in Clinical Practice (1994-2019) / Honorary Professor of Person Centred Care, Centre for Public Engagement, Joint Faculty of Health, Social Care and Education, St. George’s University Teaching Hospital Campus, University of London, UK
{"title":"The fiasco of evidence-based medicine exposed by the covid-19 pandemic","authors":"J. Couto, A. Miles","doi":"10.5750/ejpch.v8i2.1804","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1804","url":null,"abstract":"a General and Vascular Surgeon, Private Practice in Oporto, Portugal b Professor of Person Centred Care & Co-Director, European Institute for Person Centred Health and Social Care, School of Biomedical Sciences, University of West London UK / Senior Vice President/Secretary General, European Society for Person Centered Healthcare & Editor-in-Chief, European Journal for Person Centered Healthcare & Founding Editor, Journal of Evaluation in Clinical Practice (1994-2019) / Honorary Professor of Person Centred Care, Centre for Public Engagement, Joint Faculty of Health, Social Care and Education, St. George’s University Teaching Hospital Campus, University of London, UK","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"129 1","pages":"161-163"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76560365","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}
While a shift from Evidence-Based Medicine (EBM) to Precision Medicine has not yet taken place, I here argue that precision medicine has familiar problems with expertise, causes and values that we can see in Evidence-Based Medicine. Some of these similarities suggest we should be cautious in thinking of precision medicine as more person-centered than EBM.
{"title":"More Person-Centered?: The move from Evidence-Based Medicine to Precision Medicine","authors":"S. Wieten","doi":"10.5750/ejpch.v8i2.1846","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1846","url":null,"abstract":"While a shift from Evidence-Based Medicine (EBM) to Precision Medicine has not yet taken place, I here argue that precision medicine has familiar problems with expertise, causes and values that we can see in Evidence-Based Medicine. Some of these similarities suggest we should be cautious in thinking of precision medicine as more person-centered than EBM.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"19 1","pages":"226-234"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84666340","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":"the abyss is the self, and it is beautiful","authors":"J. Pheby","doi":"10.5750/ejpch.v8i2.1848","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1848","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"54 1","pages":"251-253"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86797855","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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