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Simplistic and complex thought in medicine: the rationale for a person-centered care model as a medical revolution

机译:医学中简单而复杂的思想:以人为本的医疗模式作为医学革命的基本原理

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摘要

According to the concept developed by Thomas Kuhn, a scientific revolution occurs when scientists encounter a crisis due to the observation of anomalies that cannot be explained by the generally accepted paradigm within which scientific progress has thereto been made: a scientific revolution can therefore be described as a change in paradigm aimed at solving a crisis. Described herein is an application of this concept to the medical realm, starting from the reflection that during the past decades, the medical community has encountered two anomalies that, by their frequency and consequences, represent a crisis in the system, as they deeply jeopardize the efficiency of care: nonadherence of patients who do not follow the prescriptions of their doctors, and clinical inertia of doctors who do not comply with good practice guidelines. It is proposed that these phenomena are caused by a contrast between, on the one hand, the complex thought of patients and doctors that sometimes escapes rationalization, and on the other hand, the simplification imposed by the current paradigm of medicine dominated by the technical rationality of evidence-based medicine. It is suggested therefore that this crisis must provoke a change in paradigm, inventing a new model of care defined by an ability to take again into account, on an individual basis, the complex thought of patients and doctors. If this overall analysis is correct, such a person-centered care model should represent a solution to the two problems of patients’ nonadherence and doctors’ clinical inertia, as it tackles their cause. These considerations may have important implications for the teaching and the practice of medicine.
机译:根据托马斯·库恩(Thomas Kuhn)提出的概念,当科学家由于观察到异常而遇到危机时发生了科学革命,而这种异常无法用公认的范式加以解释,在该范式中科学进步得以实现:因此,科学革命可以描述为:旨在解决危机的范式变革。本文所描述的是将这一概念应用于医学领域,从以下的反思开始:在过去的几十年中,医学界遇到了两种异常现象,它们的发生频率和后果,代表着系统的危机,因为它们严重危害了系统的安全。护理效率:不遵从医生处方的患者不依从,以及不遵照良好实践指南的医生的临床惯性。提出这些现象的原因是,一方面是患者和医生的复杂思想之间的反差,有时这种思想有时无法合理化,另一方面,当前医学范式所带来的简化是由技术理性主导的。循证医学。因此,建议这种危机必须引起范式的改变,发明一种新的护理模式,这种护理模式可以根据个人情况再次考虑患者和医生的复杂思想来定义。如果这种总体分析是正确的,那么这种以人为中心的护理模型应该可以解决患者不依从和医生的临床惯性这两个问题,因为这可以解决他们的病因。这些考虑因素可能对医学的教学和实践产生重要影响。

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