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Commentary on Discussion Paper by Miles, A and Mezzich J.E. (2011). Person-centred medicine as an emergent model of clinical practice: The devil is in the details

Cathy Charles, Amiram Gafni


Miles and Mezzich have written a comprehensive review of the origins, development and current status of two influential international movements aimed at shaping the practice of medicine - evidence-based medicine (EBM) and patient-centred care. As the authors point out, these two movements have been largely independent of each other with little crossover of ideas as each pursues its own goals of trying to broaden its influence. Miles and Mezzich propose to take the strengths of both movements and to create a new integrated model of person-centred care (PCC) which is evidence-informed (rather than evidence-based) and incorporates a role for patient values in clinical decision-making. While laudable and logical to try to move forward with this approach which integrates two seemingly contradictory principles underlying each movement (clinical practice based on the findings of clinical research evidence and clinical practice that is responsive to patients’ values, preferences and beliefs), this task is not easy and, as the authors themselves note, the model that results from this process is still in elementary form. By proposing this new integrated model, the authors hope to stimulate further debate on the meaning of a person centred-care approach to medical practice.

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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.

Gerring, J. (2001). Social Science Methodology: A Criterial Framework, p. 65. New York, NY:

Cambridge University Press.

Barry, M. & Edgman-Levitan, S. (2012). Shared Decision Making - The Pinnacle of Patient-Centered Care. New England Journal of Medicine 366 (9) 780-781.

Charles, C., Redko, C., Whelan, T., Gafni, A. & Reyno, L. (1998). Doing Nothing is No choice: Lay constructions of Treatment Decision Making in the Medical Encounter. Sociology of Health and Illness 20 (1) 71-95.

Moumjid, N., Gafni, A., Bremond, A. & Carriere, M.O. (2007). Shared Decision Making in the Medical Encounter: Are We All Talking About the Same Thing? Medical Decision Making 27 (5) 539-546.

Makoul, G. & Clayman, M.L. (2006). An integrative Model of Shared Decision Making in Medical Encounters. Patient Education and Counseling 60 (3) 301-312.

Da Silva, D. (2012). Helping people share decision making: A review of evidence considering whether shared decision making is worthwhile. London, UK. Research commissioned and funded by the Health Foundation. ISBN 978-1-906461-40-9.

Charles, C., Gafni, A. & Freeman, E. (2011). The Evidence-Based medicine Model of Clinical Practice: Scientific Teaching or Belief-Based Preaching? Journal of Evaluation in Clinical Practice 17 (4) 597-605.

Evidence-Based Working Group. (1992). Evidence-Based Medicine. A new approach to Teaching the Practice of Medicine. Journal of the American Medical Association 268 (17) 2420-2425.

Guyatt, G., Strauss, S., McAlister, F., Haynes, B., Sinclair, J., Devereaux, P.J. et. al. (2002). Moving from Evidence to Action: Incorporating patient Values. In: Users’ Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice (eds. G.H. Guyatt & D. Rennie) p. 571. Chicago IL: American Medical Association Press.

Hughes, W. (2000). Critical thinking: An Introduction to the Basic Sciences (3rd Ed), p. 50. Peterborough, ON: Broadview Press.



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