{"title":"Medical Commentary on Pheby, J. (2020). our falling and wretchedness EJPCH 8 (2) 260-262","authors":"D. Pheby","doi":"10.5750/ejpch.v8i2.1854","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1854","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"69 1","pages":"263-264"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90612027","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}
Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients’ risks being ignored.Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterize more or less developed thinking and judgment on the part of the particular practitioner.
{"title":"Person Centered Healthcare and Clinical Research: The Necessity of an Evolutionary Hierarchy of Knowing and Doing","authors":"P. Wyer, M. Loughlin","doi":"10.5750/ejpch.v8i2.1847","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1847","url":null,"abstract":"Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients’ risks being ignored.Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterize more or less developed thinking and judgment on the part of the particular practitioner.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78945268","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}
Health and disease are largely seen as structural phenomena - visible changes in tissues and organs, rather than the result of complex adaptive physiological dynamics within the person, constrained by his internal structures and external environments. Health and disease are ecological phenomena; internal structures and external environments provide the landscapes in which the functions - physiological network interactions at the micro and behavioural interactions at the macro level - occur. These interactions are the functional responses in the quest for health and life. Embracing the person as a whole, that is, being person-centered, is thus an expression of a paradigm shift, a shift from the reductionist focus on disease to the complex-adaptive understandings of the person experiencing health, illness and disease.
{"title":"Person-centeredness - A Paradigm Shift for Healthcare? From Disease as a “Structural Problem” to Health, Illness and Disease as the “Emergent Outcomes of Complex Adaptive Physiological Network Function”","authors":"J. Sturmberg","doi":"10.5750/ejpch.v8i2.1839","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1839","url":null,"abstract":"Health and disease are largely seen as structural phenomena - visible changes in tissues and organs, rather than the result of complex adaptive physiological dynamics within the person, constrained by his internal structures and external environments. Health and disease are ecological phenomena; internal structures and external environments provide the landscapes in which the functions - physiological network interactions at the micro and behavioural interactions at the macro level - occur. These interactions are the functional responses in the quest for health and life. Embracing the person as a whole, that is, being person-centered, is thus an expression of a paradigm shift, a shift from the reductionist focus on disease to the complex-adaptive understandings of the person experiencing health, illness and disease.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"89 1","pages":"164-172"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77828193","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). docility of mind, nobility of soul, sublimity of spirit EJPCH 8 (2) 255-257","authors":"D. Pheby","doi":"10.5750/ejpch.v8i2.1851","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1851","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"2 1","pages":"258-259"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80927906","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":"docility of mind, nobility of soul, sublimity of spirit","authors":"J. Pheby","doi":"10.5750/ejpch.v8i2.1850","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1850","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"117 1","pages":"255-257"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80212000","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":"Professional Doctorate in Person Centred Care UWL","authors":"A. Williamson","doi":"10.5750/ejpch.v8i2.1882","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1882","url":null,"abstract":"","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78551553","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). yes. and no. EJPCH 8 (2) 265-267","authors":"D. Pheby","doi":"10.5750/ejpch.v8i2.1856","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1856","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"12 1","pages":"268-269"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84059187","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}
Purpose: Clinical practice, and in particular decision-making, are dependent on data and knowledge which are relevant to the context at hand. Numerous frameworks have existed which aim to facilitate best clinical decision-making for healthcare professionals and their patients, for example clinical reasoning and the evidence-based healthcare models. The purpose of this paper is to provide some reconciliation between apparently conflicting models of healthcare practice with regards to best practice. Methods: We provide a theoretical narrative account of clinical practice with regards to clinical reasoning and best decision-making. We problematise the practice frameworks of clinical reasoning and evidence base healthcare by suggesting they are conflicting and contradictory to each other. We frame the arguments available with philosophical views of causation, making the assumption that causation lies central to all aspects of knowledge. We use the narrative to expose causal theories behind different practice models and illustrate our account with a case study. Results: Clinical reasoning and evidence-based healthcare are characterised by different causal theories which do not readily align with each other. By reconceptualising causation as a dispositional phenomenon, reconciliation between individualised person-centred care and the population data which are the core interest of evidence-based healthcare, can be found, thus preserving the most valuable aspects of each practice framework. Conclusion: Reconceptualising causation in dispositionalist terms facilitates a more person-centred, multi-dimensional clinical reasoning process. This in-turn allows for the integration of data from prioritised methods of evidence-based healthcare into complex and context-sensitive individualised clinical situations.
{"title":"Person-centred clinical reasoning and evidence-based healthcare","authors":"R. Kerry, M. Low, P. O'Sullivan","doi":"10.5750/ejpch.v8i2.1845","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1845","url":null,"abstract":"Purpose: Clinical practice, and in particular decision-making, are dependent on data and knowledge which are relevant to the context at hand. Numerous frameworks have existed which aim to facilitate best clinical decision-making for healthcare professionals and their patients, for example clinical reasoning and the evidence-based healthcare models. The purpose of this paper is to provide some reconciliation between apparently conflicting models of healthcare practice with regards to best practice. Methods: We provide a theoretical narrative account of clinical practice with regards to clinical reasoning and best decision-making. We problematise the practice frameworks of clinical reasoning and evidence base healthcare by suggesting they are conflicting and contradictory to each other. We frame the arguments available with philosophical views of causation, making the assumption that causation lies central to all aspects of knowledge. We use the narrative to expose causal theories behind different practice models and illustrate our account with a case study. Results: Clinical reasoning and evidence-based healthcare are characterised by different causal theories which do not readily align with each other. By reconceptualising causation as a dispositional phenomenon, reconciliation between individualised person-centred care and the population data which are the core interest of evidence-based healthcare, can be found, thus preserving the most valuable aspects of each practice framework. Conclusion: Reconceptualising causation in dispositionalist terms facilitates a more person-centred, multi-dimensional clinical reasoning process. This in-turn allows for the integration of data from prioritised methods of evidence-based healthcare into complex and context-sensitive individualised clinical situations.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"3 1","pages":"215-225"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80236650","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}
Drawing on an authentic sickness history the present paper provides arguments for epistemological and ontological shifts in current clinical practice. The kind of sickness accounted for, impairing the health of a person to the extent of full incapacitation, is medically unexplained. Likewise, its pathogenic sources are unidentified, which results in a lack of options for treatment or even amelioration. Given the considerable healthcare investment in this particular “case”, the insufficiency of both diagnostic and therapeutic approaches calls for a different conceptual framework. When applying a socially and phenomenologically informed frame of reference, the lived experience of violation emerges as a salient background for understanding how disrespect and powerlessness have been inscribed with lifelong impact and how they became reactivated by biographic particularities reminiscent of previous objectification. A biomedically unexplained incapacitation is rendered logical when read with a view recognizing the social and corporeal aspects of human experience.
{"title":"The lived body - a historical phenomenon","authors":"E. Thornquist, A. L. Kirkengen","doi":"10.5750/ejpch.v8i2.1840","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1840","url":null,"abstract":"Drawing on an authentic sickness history the present paper provides arguments for epistemological and ontological shifts in current clinical practice. The kind of sickness accounted for, impairing the health of a person to the extent of full incapacitation, is medically unexplained. Likewise, its pathogenic sources are unidentified, which results in a lack of options for treatment or even amelioration. Given the considerable healthcare investment in this particular “case”, the insufficiency of both diagnostic and therapeutic approaches calls for a different conceptual framework. When applying a socially and phenomenologically informed frame of reference, the lived experience of violation emerges as a salient background for understanding how disrespect and powerlessness have been inscribed with lifelong impact and how they became reactivated by biographic particularities reminiscent of previous objectification. A biomedically unexplained incapacitation is rendered logical when read with a view recognizing the social and corporeal aspects of human experience.","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"28 1","pages":"173-182"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81302317","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). the abyss is the self, and it is beautiful. EJPCH 8 (2) 251-253","authors":"D. Pheby","doi":"10.5750/ejpch.v8i2.1849","DOIUrl":"https://doi.org/10.5750/ejpch.v8i2.1849","url":null,"abstract":"No abstract","PeriodicalId":72966,"journal":{"name":"European journal for person centered healthcare","volume":"45 1","pages":"254"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88075289","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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