Published eLetters
If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.
Jump to comment:
- Page navigation anchor for RE: Failure of the Problem-Oriented Medical Paradigm and a Person-Centered ApproachRE: Failure of the Problem-Oriented Medical Paradigm and a Person-Centered Approach
Hey, the Emperor has no clothes and is leading the parade in the wrong direction. Dr. Mold calls out the painful, embarrassing truth and provides a solution – put on some clothes and get to know your subjects (patients).
We all know and continually witness the fragmenting and reductionistic trends in practice and the damage it has caused to connections with our patients as it threatens the soul of medicine. Yet, what can we do and how can we respond to such overwhelming obstacles to make positive change.
Finally, we have a path. In a few short pages, Dr. Mold has identified the problem and conceptualized the solution. Just as the PCMH provided a blueprint to help make sense of the comprehensive scope of family medicine and provide actionable steps to deliver high quality, safe and coordinated care, Dr. Mold’s Goal-Oriented Care reconnects us with the foundational values of medicine. People’s lives and problems are messy. Identifying and addressing the 4 basic goals of our patients is a simple way to establish a true healing relationship with our patients and to focus on issues that matter to them in a way that also achieves the Quadruple Aim.
It is hard to create both revolutionary and evolutionary ideas in one package. Congrats and hooray to Dr. Mold.
Competing Interests: None declared. - Page navigation anchor for RE: How to perform a person-centred consultationRE: How to perform a person-centred consultation
Dear James,
great article on a person-centered and goal-oriented medicine.
To promote the integration of these aims within the daily medical decision-processes is also one of my basic interests.
Unfortunately, the needed medical attitude and communication skills to include the patient in a solution- and goal-oriented person-centered medicine are not or only insufficiently taught at most medical schools.
From many years of cooperation with experienced doctors, we have learned that there is a real need for repeated reflection on one's own medical practice and professional attitude, as well as for training the necessary communication skills. Preferably in supervised peer group meetings.
All our experience we have summarized in the book "Mastering the Medical Consultation - A Systemic, Solution-Oriented Process", Bruno Kissling, Peter Ryser, Free Association Books, London, 2021. (The German Original being awarded with the Book Prize of the European Society for Person-Centered Healthcare ESPCH)
The book goes through the consultation, step by step. It contains a pracitcal tool with samples of questions which involve the patient actively within the whole analyzing, "assessing" and therapeutic process. We show ways, how to build a sustainable relation between doctor and patient (the foundation of any collaboration); how to meet the patient on an equal footing - like two experts: the patient being the expert of...
Show MoreCompeting Interests: Co-author of the book "Mastering the Medical Consultation - A Systemic, Solution-Oriented Process", Bruno Kissling, Peter Ryser, Free Association Books, London, 2021 - Page navigation anchor for A person-centered health system – it is within our reachA person-centered health system – it is within our reach
That medicine is complex [1] has already been known to Hippocrates in ancient times, and William Osler [2] and Ian McWhinney [3, 4] in the 20th century. Their calls for a new paradigm, one based on the ‘person’s needs at the centre of the system’, have long been ignored, though over the past 25 years many colleagues have called for it with Barbara Starfield [5, 6] and Andrew Miles leading the effort [7, 8].
Show More
The fundamental problem with all our health systems is their focus on disease. Our medical curricula all center around learning about diseases and their management in the abstract, and we rarely [9-11] if ever expose our medical students to patients’ experiences of what it means to live with their diseases. Consequently, we also never really assess their capabilities to acting as physicians who are able to apply their instrumental skills empathically in the context of a patient’s context and health goals [12, 13]. By the end of their course students have little if any appreciation that their patients’ mostly ‘good health’ experiences despite their ailments – their well-being emerges from adaptation with the frame of health being a balance between the physical, emotional, social and sense-making domains (the somato-psycho-socio-semiotic (SPSS) model of health) [14, 15].
The lack of professional as well as public discourse about the nature of health and health care entrenches and perpetrates the prevailing – more accurately called – disease management system....Competing Interests: None declared. - Page navigation anchor for RE: Failure of the Problem-oriented medical paradigmRE: Failure of the Problem-oriented medical paradigm
Excellent paper! I've had similar issues dealing with the treatment teams of my 91 year-old father. I recall reading Thomas Kuhn in the seventies and wondered how long it would take to shift the paradigm that led me into family medicine, and then geriatrics, back then. I know they say it takes a couple of decades to change, but I'm not so certain medicine will "see the light" in my lifetime.
Competing Interests: None declared.