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Adaptive many model medicine trumps monocultural models: comment on the Miles and Mezzich emergent model of modern clinical practice

Robin Nunn


In their provocative and insightful discussion paper, Miles and Mezzich consider two parallel, but philosophically divergent movements in medicine: evidence-based medicine and patient-centered care. They call for the integration or coalescence of these contrasting movements into one model that "combines the strengths of both movements, but which dispenses with the weaknesses of each." I share their goal of placing the person at the center of medicine, rather than subordinating the person to the depersonalized science and technology represented by current models of evidence-based medicine. Yet I envision a person-centered model, indeed any medical model, not as an overriding unified entity, but rather as one component in a complex "many model medicine". I have tried to show elsewhere that the use of many models is likely to produce better outcomes than the dominance of any single model. Multiple models entail multiple perspectives and methods that may be necessary to solve difficult medical problems. This pluralistic view is consistent with Peabody's view, cited in the discussion paper, that medical art and science are not opposites, but are foundational components of medicine.

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Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person- centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Nunn, R. (2012). Many-models medicine: diversity as the best medicine. Journal of Evaluation in Clinical Practice 18, 974-978.

Nunn, R. (2008). Evidence-based medicine and limits to the literature search. Journal of Evaluation in Clinical Practice 14, 672–678.



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