The Patient as a Person: An Integrated and Systemic Approach to Patient and Disease

Description:

In the current era, evidence-based medicine and various supporting technologies dominate everyday clinical practice, according to a disease-centred, as opposed to patient-centred, approach. They have obviously improved the clinical management of diseases and it is therefore unreasonable to think of a medicine in which they are not considered fundamental. In fact, the strength of the new medicine should be to adapt scientific knowledge to a specific clinical case.

This book therefore looks at the prospect of a new ‘person’ centred medicine, which stands alongside the ‘disease’ and ‘patient’ centred medicine, which pays special attention to the subjectivity of scientific knowledge and the relationship between doctor and patient. It is important to emphasise that this book is written by several hands, i.e. by experts from different fields, doctors, philosophers, architects, sociologists, art critics, physicists and engineers. This is with the intention of providing as broad a perspective as possible on the doctor-patient relationship.

Due to its translational and multicultural approach to the subject, the book will be of interest to a wide readership, from medical experts to students, psychologists, philosophers and institutional actors.

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Preface

In the current era of Medicine, the scientific approach—that is evidence-based medicine—and technical systems—that is diagnostic imaging, informatics supports, bio-engineering, robotics—dominate everyday clinical practice, according to an approach centred on the disease and not on the patient. Definitely, they have improved clinical management of diseases, from early diagnosis to specific treatment, whether pharmacological or surgical, and so it is unreasonable to think of medicine without them. The question is whether it is conceivable to go beyond a scientific approach, based on large numbers, in which the patient, as a single unit, plays a central role in the medical pathway, while also taking his or her subjectivity into account also. Thus, the strength of the new medicine should be to adapt scientific knowledges to a clinical case. There are several points highlighting this issue: (1) the search for a systemic approach to illness and disease prevention in which, for example, psychological and environmental aspects cannot be disregarded; (2) the increasingly frequent demand for complementary approaches that flank state-ofthe-art medical and surgical treatment of diseases with a view to taking care of the person as well as treating the disease; (3) the personalization of medicine that promotes a patient-centred approach, according to P4 medicine, that is predictive, preventive, personalized and participative; (4) the anthropocentrism proposed by new medical approaches, such as the Humanistic Medicine, Systems Medicine and the Biopsychological model, that promote an integrative, holistic and personalized approach, highlighting that biological, psychological and social factors may contribute to the occurrence and progression of diseases; (5) a new interpretation of the relationship between doctor and patient, with a more active and direct involvement of patients in the diagnostic and therapeutic pathways, which should lead to a greater awareness of the disease on the part of patients; dialogue can be based on this new relation with narrative medicine that can potentially give a chance; (6) the complexity of the human being, which is a non-linear, dynamic and interwoven network of organs and systems working to maintain physiological homeostasis, and which often determines an individual and unforeseen physiological and pathophysiological response, therefore, thus requiring a personalized approach.

The aim of this book is therefore to look at these new aspects of medicine from a person-centred perspective that goes beyond disease-centred and the patientcentred medicine, with a focus on the subjective aspects of scientific knowledge, the relationship between doctor and patient and the opportunity to care for the patient as a person, as well as to treat the disease.
The connections between philosophy and medicine, which could actually be considered as two disciplines running on two parallel tracks without any possible point of conjunction, is quite easy to glimpse if we consider that both disciplines have the human being as their sole object of study: this favours looking at patients in their complexity and in undefined facets. Leafing through the pages of this book one will come across different writing modes and languages, from philosophical, medical and biological, to physical and engineering, as well as artistic and architectural culture. We believe that this blend of languages and topics is the true richness of this book.

Pisa, Italy Alessandro Pingitore
Pisa, Italy Alfonso Maurizio Iacono

Preface
Contents
Part I: Between the Doctor and the Patient
Chapter 1: Between the Doctor and the Patient: History of the Relationship
Introduction
Prehistoric Times and Early Medicine
Mesopotamia and Egypt
Greeks and Romans
From Medieval Europe to 1800
The Development of a Patient-Centred Medicine
Conclusions
References
Chapter 2: The Relationship Between the Doctor and the Patient: The Ancient Conceptions of Philosophy as Medicine
Philosophy as Medicine
The Quadripartite Model of Medicine and the Therapeutic Goals of the Philosopher-Doctor
Treatment Methods and the Relationship Between Doctor and Patient
References
Chapter 3: Between the Doctor and the Patient: Origins of an Intermediate World
Plato’s Prisoners
Damasio and the Self That Comes to Mind
Put Yourself in the Place of Another and Yourself
Play and Change
The Multiple Realities and the Intermediate Worlds
The Copy and the Substitute
Multiple Realities and In-Between Worlds
References
Chapter 4: A Systemic Approach to Health and Disease: The Interaction of Individuals, Medicines, Cultures and Environments
Introduction
The Systemic Approach
The Biomedical Model of Health
The Eclipse of the Universal Subject and the Emergence of the Situated Subject
Micromacro and Macromicro
A Sociology of Chemical Processes?
The Organization of Work and Circadian Rhythms
Which Health Model? A Few Proposals
Conclusion
References
Chapter 5: The Ward as a Scene
Naturalisation of Roles: That of Doctor and Patient in the Ward
Sympathy
Empathic Imagination
Bibliography
Chapter 6: Between the Doctor and the Patient: The Role of the Unconscious in the Relationship
Introduction
Interpersonal Communication Skills and Relationship Contexts
Models of Doctor-Patient Relationship
The Role of Unconscious in the Doctor-Patient Relationship
Social Cognition: Theory of Mind
Social Cognition: Empathy
Brain Areas Involved in the Response to the Needs of the Patient
Conclusions and Future Directions
References
Chapter 7: The Medical Doing on the Person
Bibliography
Siteography
Chapter 8: Consent and Trust in the Doctor Patient Relationship
References
Chapter 9: Big Data and Precision Medicine
References
Chapter 10: Rehabilitation After a Disease: What Is “Normality” After an Invalidating Disease?
Suggested Reading
Part II: The Patient as a Person and the Disease
Chapter 11: Toward Patient Care: Integrative and Complementary Approaches
Introduction
History and Definitions
Self-Management and Patient Empowerment
Complementary Health Approaches: An Intermingled Connection Between Mind, Body, and Spirituality
Discussion
References
Chapter 12: Human Complexity: A Symphony of Vital Rhythms
Introduction
The Subconscious Mind
Self-Organization of Rhythms
Crucial Events
Three Forms of Complexity and 1/f Noise
Complex Rhythms
Autonomic Neuropathy
Meditation
Top-Down or Bottom-Up Approach to Consciousness?
Caring Versus Curing
Therapies for Both Parkinson and Alzheimer
Conclusions
Group Mind
Einstein’s Legacy
A New Approach to Quantum Mechanics
Bounded Rationality
Autopoiesis
References
Chapter 13: Spirituality in Medicine: A New Dimension in the Light of a Millennial Tradition
Introduction
Spirituality, Contemplative Practices and Science
The Illness, the Treatment, the Death, the Compassion in the Buddhist Tradition
The New Dimension of Spirituality in the Relationship of Cure
The Institutional Context
The Individual Context
Conclusions
References
Chapter 14: The Body of Descartes and Humanism in Medicine
The Body and the Mechanistic Theory of Nature
The Body and Soul of Descartes
Reduction of Complexity
Cartesian Distinction Between Machines, Animals and Men
Language and Reason Outside the Body
The Language
The Mind and Language Excluded from Corporeality
Biomedical Model and Its Evolution
Humanistic Medicine in the Context of a Model of New Medicine
Conclusion
References
Chapter 15: The History of Narrative Medicine: A Way to Know the Patient Dimension Between Apollonian and Dionysian
The Here and Now
The Patient Dimension
The Mythos and Reinforcement of Human Qualities in Pandemic Ages
References
Chapter 16: To Care for a Patient as a Person: Emotional Architecture of the Environment
Hospital as a Social Architecture
Quality of Spaces and Soft Qualities
Finishing Materials and Furniture
Wayfinding and Orientation
Green Spaces and Healing Gardens
Users’ Comfort and Indoor Air Quality (IAQ)
Design for All
New Perspectives for Increasingly Healing Hospitals
References
Chapter 17: Beauty Saves. Culture Cures
Classical vs Conceptual Art: From Aesthetic Perceptive Experiences to Ecstatic Sharing
The Historical Avant-Gardes: Anti-Beauty That Generates Pleasure
Present-Day Museology: Include, Empower, Cure, and Spread a Sense of Well-Being
Curing the Soul: Museotherapy and the Search of Self
Chapter 18: An Integrated and Systemic Approach to the Patient: Beyond Evidence Based Medicine
Healthcare and Patient Centeredness
My Personal Experience of Relationships with Sick People
References
Chapter 19: Medicine: The Science In-Between
References
Chapter 20: A Dialogue Between a Philosopher and a Doctor
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Conclusion
Bibliography