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Defining “Patient-Centered Medicine”

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What is the proper relation between a scientific understanding of disease and the subjective phenomenon of being sick? Charles L. Bardes, M.D. discusses “Patient-centered medicine” concept.

Image courtesy of interviewee. February 20, 2024

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This video video discusses the concept of patient-centered medicine, which emphasizes prioritizing the needs and concerns of patients over a disease-centered or doctor-centered approach. Originating in the 1960s, this approach critiques traditional medical practices that may treat patients as mere components of a disease management system. The speaker outlines the historical duality in medicine: the delivery of medical technologies and the care of individuals' subjective experiences of illness.

This video video critiques the current healthcare purchasing model in the U.S., which complicates consumer choice due to various filters like doctors and insurers, potentially obscuring costs. It also highlights that healthcare decisions can be driven by intense emotions, especially when the stakes are high, such as with a sick child.

While advocating for greater attention to patients' experiences, the speaker suggests that neither patients nor doctors can be viewed as the sole center of care. Instead, a more interconnected model is proposed, likening the relationship to a binary star system or the double helix structure of DNA, emphasizing the mutual dependence of patients and healthcare providers. This video video concludes by referencing the caduceus symbol, traditionally depicting two serpents, to illustrate the interwoven relationships in healthcare.

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Well, patient centered medicine is an idea

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that we should redirect our foremost attention towards the

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needs and concerns of the patient.

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The term first appeared in the 1960s in the field

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of psychiatry and rapidly gained traction throughout

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medicine society, and it basically implies a contrast

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with whatever is not patient centered,

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and that could be conceived as disease centered

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or doctor centered, but

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something different from the patient.

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As the center. Throughout its long history,

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medicine has always invoked two principles,

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and one is the delivery of certain technologies,

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whatever the technology of the day may be.

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Uh, but the other is something more like the care of souls.

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And the first, the delivery

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of technologies focuses on the mechanics

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of disordered physiology.

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But the second,

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more on the subjective experience of being ill.

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So the idea here is that

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by focusing attention on the patient,

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patient-centered medicine, both implicitly

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and explicitly, critiques a version of medicine

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that focuses on the disease rather than on

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the person with the disease.

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So that, in a system

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that is not patient-centered,

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the patient can sometimes feel like a cog in a

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disease treating machine.

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And in this sense, it parallels

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to some degree 19th century awareness of

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how the industrial assembly line can transform a person into

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a thing, which is a concept that the Germans call fingal,

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or for that matter, a 21st century,

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worker pushing pixels on a computer screen,

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less human, more mechanistic.

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And by the way, doctors can feel this way too sometimes,

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just as if they were servants

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to the electronic medical record.

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Now, in a consumer society, individuals consider

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what they want and they choose to purchase it

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or not based on its cost

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and how it compares with their other priorities.

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But healthcare, purchasing strains this model in important

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ways, especially in the, in the United States.

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Uh, there are filters between the patients

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and their ability to obtain what they want.

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Uh, the filter could be a doctor or an insurer,

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or the NHS.

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Uh, the cost is often invisible both

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to the patients and to the doctors.

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A third point is that consumers often think about costs

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to themselves as individuals,

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but healthcare often involves cost to society as a whole.

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Now, this is not unique to medical purchasing,

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and I imagine that the Britains,

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do this better than the Americans.

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But, if you're thinking only about the cost to yourself,

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you're unaware of the cost to society as a whole.

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And consumer desire, is often driven

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by advertising, by buzz, by hearsay.

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Now, this is also not unique to medicine, of course,

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but healthcare decisions can be, extremely emotional,

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often uniquely so,

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and I realize that other purchases can be, emotional,

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but to the parent of a sick child, the benefit

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of a cure is nearly infinite,

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Or even the prospect of a cure is nearly infinite.

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But the cost often becomes an abstraction.

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So what is the meaning, in US dollars of a cure

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that costs a hundred thousand dollars or a million dollars

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or $10 million, or a hundred million dollars?

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And these become just abstract numbers, that,

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are very hard to conceive.

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Well, when you think about, the metaphor of the patient

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as a center, you think about other analogies,

03:26.025 --> 03:27.685
of centeredness, for example.

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Uh, do we live in a tmeic universe where the

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sun rotates around the earth

03:35.175 --> 03:36.715
or a Copernican universe

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where the earth rotates around the sun?

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Uh, those are the sorts of things

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that we think about in terms of a center.

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Uh, but the flaw in the idea of the patient of center,

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by the way, I mean, I, I do advocate the idea

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that the patient,

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that more attention should be directed towards the

03:56.225 --> 03:59.705
subjective experiences of the patient,

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and their, and what they're experiencing.

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But, they're not entirely the center

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because neither the doctor

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nor the patient can be the unique center.

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Uh, they have to co-exist in a therapeutic and social

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and economic relationship, that is highly interwoven.

04:21.035 --> 04:23.255
So when we think about, metaphors,

04:23.275 --> 04:25.655
we might think instead about a binary star system

04:25.655 --> 04:28.495
where the two stars orbit around each other,

04:29.035 --> 04:32.255
or the double helix of DNA in which the two strands

04:32.795 --> 04:33.855
and circle each other.

04:34.715 --> 04:37.455
Or if you go back to ancient medicine to the caduceus,

04:37.455 --> 04:40.815
and I realize that the most ancient caduceus is a single

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serpent wrapped around a staff, but there's a later image,

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and this is the one you see more often

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of two serpents wrapped around a staff,

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and they intertwine forever.

Understanding Patient-Centered Medicine

00:00:00 - Well, patient centered medicine is an idea that we should redirect our foremost attention towards the needs and concerns of the patient. The term first appeared in the 1960s in the field of psychiatry and rapidly gained traction throughout medicine society, and it basically implies a contrast with whatever is not patient centered, and that could be conceived as disease centered or doctor centered, but something different from the patient. As the center. Throughout its long history, medicine has always invoked two principles, and one is the delivery of certain technologies,
00:00:36 - but the other is something more like the care of souls. And the first, the delivery of technologies focuses on the mechanics of disordered physiology. But the second, more on the subjective experience of being ill. So the idea here is that by focusing attention on the patient, patient-centered medicine, both implicitly and explicitly, critiques a version of medicine that focuses on the disease rather than on
00:01:07 - So that, in a system that is not patient-centered, the patient can sometimes feel like a cog in a disease treating machine. And in this sense, it parallels to some degree 19th century awareness of how the industrial assembly line can transform a person into a thing, which is a concept that the Germans call fingal, or for that matter, a 21st century, worker pushing pixels on a computer screen,
00:01:38 - And by the way, doctors can feel this way too sometimes, just as if they were servants to the electronic medical record. Now, in a consumer society, individuals consider what they want and they choose to purchase it or not based on its cost and how it compares with their other priorities. But healthcare, purchasing strains this model in important ways, especially in the, in the United States. there are filters between the patients and their ability to obtain what they want. the filter could be a doctor or an insurer,
00:02:09 - the cost is often invisible both to the patients and to the doctors. A third point is that consumers often think about costs to themselves as individuals, but healthcare often involves cost to society as a whole. Now, this is not unique to medical purchasing, and I imagine that the Britains, do this better than the Americans. But, if you're thinking only about the cost to yourself, you're unaware of the cost to society as a whole. And consumer desire, is often driven
00:02:42 - Now, this is also not unique to medicine, of course, but healthcare decisions can be, extremely emotional, often uniquely so, and I realize that other purchases can be, emotional, but to the parent of a sick child, the benefit of a cure is nearly infinite, Or even the prospect of a cure is nearly infinite. But the cost often becomes an abstraction. So what is the meaning, in US dollars of a cure that costs a hundred thousand dollars or a million dollars

Centering Patients: Metaphors and Relationships

00:03:13 - And these become just abstract numbers, that, are very hard to conceive. Well, when you think about, the metaphor of the patient as a center, you think about other analogies, of centeredness, for example. do we live in a tmeic universe where the sun rotates around the earth or a Copernican universe where the earth rotates around the sun? those are the sorts of things
00:03:45 - but the flaw in the idea of the patient of center, by the way, I mean, I, I do advocate the idea that the patient, that more attention should be directed towards the subjective experiences of the patient, and their, and what they're experiencing. But, they're not entirely the center because neither the doctor nor the patient can be the unique center.
00:04:15 - and economic relationship, that is highly interwoven. So when we think about, metaphors, we might think instead about a binary star system where the two stars orbit around each other, or the double helix of DNA in which the two strands and circle each other. Or if you go back to ancient medicine to the caduceus, and I realize that the most ancient caduceus is a single serpent wrapped around a staff, but there's a later image,
00:04:48 - of two serpents wrapped around a staff, and they intertwine forever.

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