Humanistic medicine

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Humanistic medicine is an interdisciplinary field in the medical practice of clinical care popular in the modern health systems of developed countries.

Contents

Problems facing healthcare

In many countries with modern healthcare systems, healthcare systems are facing enormous difficulties in meeting demands given limited healthcare budgets. Healthcare professionals often experience high levels of stress and burnout . Health professionals facing a large number of patients are not giving individual patients the care they want, resulting in a very high number of patients seeking alternative treatments and rejecting vaccinations for their children. The rising costs of medical services and medication are becoming unaffordable for many patients , preventing these individuals from receiving adequate healthcare without spending a large percentage of their disposable income. Studies have shown that poor doctor-patient relationships result in frequent lawsuits against healthcare providers. [1] These lawsuits have become a major burden to medical personnel and have risen in both number and cost in developed nations.[ citation needed ]

Practice

Among the approaches used to encourage the practice of a more humane medicine are narrative medicine and patient empowerment. Narrative medicine is a way of educating physicians, nurses and other providers that uses storytelling (and active listening) to emphasize the humanity of patient and provider, enabling the "physician to practice medicine with empathy, reflection, professionalism, and trustworthiness." Patient empowerment seeks to create an equal partnership between doctors and their patients, placing values at the center of the healthcare encounter. [2] [3] Both of the practices emphasize the importance of the human experience in the practice of medicine, and help to ensure that the humanity of the patient is not obscured in a morass of lab results, patient charts, and insurance regulations. Humanistic medicine strives to create ideal and balanced care that sacrifices neither cutting-edge science nor the gentle art of creating a caring relationship. Various health professional schools across the U.S. have begun to integrate humanistic medical teaching into their curricula in an effort to offset what some view as an over-emphasis on medical technology to the detriment of individual patient care.

Criticism

It is not widely accepted that "humanistic medicine" refers to a belief or set of practices that differ significantly from the biopsychosocial model of care. Further, many of the terms used by its advocates such as "soul" and "spiritual" are not well defined nor specifically explored experimentally inasmuch as these approaches contribute to patient welfare beyond those employed by the biopsychosocial model.

Related Research Articles

<span class="mw-page-title-main">Medicine</span> Diagnosis, treatment, and prevention of illness

Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

<span class="mw-page-title-main">Biopsychosocial model</span> Explanatory model emphasizing the interplay among causal forces

Biopsychosocial models are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in topics ranging from human development to health and disease.

Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.

A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.

<span class="mw-page-title-main">Primary care</span> Day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.

The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. The trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties.

Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors agree to provide enhanced care, including commitments to ensure adequate time and availability for each patient.

<span class="mw-page-title-main">Narrative medicine</span> Medical approach

Narrative Medicine is the discipline of applying the skills used in analyzing literature to interviewing patients. The premise of narrative medicine is that how a patient speaks about his or her illness or complaint is analogous to how literature offers a plot with characters and is filled with metaphors, and that becoming conversant with the elements of literature facilitates understanding the stories that patients bring. Narrative Medicine is a diagnostic and comprehensive approach that utilizes patients' narratives in clinical practice, research, and education to promote healing. Beyond attempts to reach accurate diagnoses, it aims to address the relational and psychological dimensions that occur in tandem with physical illness. Narrative medicine aims not only to validate the experience of the patient, it also encourages creativity and self-reflection in the physician.

In economics, supplier induced demand (SID) may occur when asymmetry of information exists between supplier and consumer. The supplier can use superior information to encourage an individual to demand a greater quantity of the good or service they supply than the Pareto efficient level, should asymmetric information not exist. The result of this is a welfare loss.

Shared decision-making in medicine (SDM) is a process in which both the patient and physician contribute to the medical decision-making process and agree on treatment decisions. Health care providers explain treatments and alternatives to patients and help them choose the treatment option that best aligns with their preferences as well as their unique cultural and personal beliefs.

<span class="mw-page-title-main">Cultural competence in healthcare</span> Health care services that are sensitive and responsive to the needs of diverse cultures

Cultural competence in healthcare refers to the ability for healthcare professionals to demonstrate cultural competence toward patients with diverse values, beliefs, and feelings. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of their race, gender, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive payments for their services rendered from health insurance providers.

Clinical empathy is expressed as the skill of understanding what a patient says and feels, and effectively communicating this understanding to the patient. The opposite of clinical empathy is clinical detachment. Detached concern, or clinical detachment, is the ability to distance oneself from the patient in order to serve the patient from an objective standpoint. For physicians to maximize their role as providers, a balance must be developed between clinical detachment and clinical empathy. Recent research suggests that clinical empathy may be cost-effective.

References

  1. Beckman, Howard (1994). "The Doctor-Patient Relationship and Malpractice Lessons From Plaintiff Depositions". JAMA Internal Medicine. 154 (12): 1365–1370. doi:10.1001/archinte.1994.00420120093010. PMID   8002688.
  2. Kelly, M; Heath, I; Howick, J; Greenhalgh, T (2015). "The importance of values in evidence-based medicine". BMC Medical Ethics. 16 (69): 69. doi: 10.1186/s12910-015-0063-3 . PMC   4603687 . PMID   26459219.
  3. Fulford, KWM; Peile, H; Carroll, H (March 2012). Essential Values-Based Practice. Cambridge University Press. ISBN   9780521530255.
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