Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine
Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine
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DOI：
10.1016/s0738-3991(99)00087-7
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发表时间：
2000-01-01
影响因子：
3.5
通讯作者：
Bensing, J
中科院分区：
文献类型：
--
作者：
Bensing, J
现代医学受到两种范式的影响：“循证医学”和“以病人为中心的医学”。在过去的十年中，这两种范式迅速获得普及，现在都应该影响临床决策的过程中，我在医生的日常实践。然而，仔细分析表明，它们侧重于医疗保健的不同方面，实际上几乎没有共同之处。循证医学是一个相当年轻的概念，在20世纪90年代初进入科学文献。它基本上是一个实证主义的，生物医学的视角。它的重点是为临床医生提供最好的证据，为他们的病人提供最充分的治疗，认为医学仅仅是一种认知理性的事业。在这种方法中，患者的独特性，他们的个人需求和偏好，以及他们的情绪状态很容易被忽视，作为决策的相关因素。以病人为中心的医学，虽然不是一个新现象，但最近再次引起了人们的关注。它基本上具有人文主义、生物心理社会学的视角，结合了“理想医生”的伦理价值观、促进患者揭示真实的担忧的心理治疗理论和决策的谈判理论。它通过考虑患者的观点，并根据患者的需求和偏好调整医疗护理，重点关注患者参与临床决策。然而，在这种方法中，意识形态基础比证据基础发展得更好。在现代医学中，这两种范式高度相关，但似乎属于不同的世界。在不久的将来，我们面临的挑战是将这些不同的世界融合在一起。本文的目的是推动这种整合。这两种范式的发展都可以从交换思想和原则中受益，最终医疗保健将从中受益。在这一过程中，传播和传播研究将发挥关键作用。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision I making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and communication research. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.