Canadian Journal of Psychiatry 55:701-708, 2010

Person-centered Integrative Diagnosis:Conceptual Bases and Structural Model

Juan E. Mezzich, MD, PhD1, Ihsan M. Salloum, MD, MPH2, C. Robert Cloninger,MD3, Luis Salvador-Carulla, MD4, Laurence J. Kirmayer, MD5,

Claudio E. M. Banzato, MD, PhD6, Jan Wallcraft, PhD7,, and Michel Botbol, MD8

1. Professor of Psychiatry, Mount Sinai School of Medicine, New York University, New York, USA; President of the World Psychiatric Association 2005-2008; President of the International Network for Person-centered Medicine.

2. Professor of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA; Chair, Section on Classification, Diagnostic Assessment and Nomenclature, World Psychiatric Association.

3. Wallace Renard Professor of Psychiatry, Genetics, and Psychology; Director, Center for Wellbeing, Washington University School of Medicine, St Louis, Missouri, USA.

4. Professor of Psychiatry, University of Cadiz, Cadiz, Spain; Head of the Research Unit, Fundació Villablanca, Reus, Spain; Secretary, Section on Classification, Diagnostic Assessment and Nomenclature, World Psychiatric Association.

5. James McGill Professor and Director, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.

6. Associate Professor of Psychiatry, University of Campinas (UNICAMP), Brazil.

7. Visiting Fellow, Centre for Mental Health Recovery, University of Hertfordshire, UK; Honorary Fellow, University of Birmingham, UK.

8. President, WPA French Member Societies Association; Associate Professor, School of Psychology, Catholic University of Paris; Consultant on Juvenile Justice to the Ministry of Justice, Paris, France.

Corresponding author: Juan E Mezzich, MD, PhD. Professor of Psychiatry, Mount Sinai School of Medicine, New York University, 5th Avenue and 100th Street, Box 1093, New York, New York 10029, USA. <juanmezzich@aol.com>

Key Words:Psychiatry and Medicine for the Person, Comprehensive Health, Diagnosis, Classification, Shared Understanding, Shared Decision-making, Partnership, Integration of Services, Person-centred Integrative Diagnosis.

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Funding and Support Statement: The authors did not receive any funding for this project beyond the In Review honorarium. Abstract

Objectives

To review the conceptual bases of Person-centered Integrative Diagnosis as a component and

contributor to person-centered psychiatry and medicine and to outline its design and

development.

Method

An analysis was conducted of the historical roots of person-centered psychiatry and medicine,

tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern

medicine, to recent clinical and conceptual developments, and to emerging efforts to repriorityze

medicine from disease to patient to person in collaboration with the World Medical Association,

the World Health Organization, the World Organization of Family Doctors, the World

Federation for Mental Health and a number of other global health entities, and with the

coordinating support of the International Network for Person-centered Medicine.

Results

One of the prominent endeavors within the broad paradigmatic health development outlined

above is the design of Person-centered Integrative Diagnosis (PID). This diagnostic model

articulates science and humanism to obtain a diagnosis of the person (of the totality of the

person’s health, both ill and positive aspects), by the person (with clinicians extending

themselves as full human beings), for the person (assisting the fulfillment of the person’s health

aspirations and life project), and with the person (in respectful and empowering relationship with

the person who consults). This broader and deeper notion of diagnosis goes beyond the more

restricted concepts of nosological and differential diagnoses. The proposed Person-centered

Integrative diagnostic model, is defined by three keys: a) broad informational domains, covering

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both ill health and positive health along three levels: health status, experience of health, and

contributors to health, b) pluralistic descriptive procedures (categories, dimensions and

narratives), and c) evaluative partnerships among clinicians, patients and families. An unfolding

research program is focused on the construction of a practical guide and its evaluation, followed

by efforts to facilitate clinical implementation and training.

Conclusions

Person-centered integrative diagnosis is aimed at appraising overall health through pluralistic

descriptions and evaluative partnerships, and leading through a research program to more

effective, integrative and person-centered health care.

Clinical Implications

Bringing the whole person of the patient to the foreground of clinical work

Covering both illness and wellbeing to enhance restoration and promotion of heath

Fostering partnerships for shared understanding and shared decision making

Using narratives to address meaning and deepen understanding and healing

Limitations

Time challenges to the implementation of comprehensive diagnosis

Pending validation of the proposed diagnostic model

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Introduction

Person-centered psychiatry and medicine are emerging as new paradigms in response to

increasing recognition of the limitations of current medical care, the importance of a

biopsychosocial framework for understanding both ill and positive health, the need to promote

the autonomy, values and dignity of the person who consults, and the diversity of patient

populations. Person-centered psychiatry and medicine aim to put the whole person rather than

disease at the center of health care, through systematic attention to lived experience, clinical

communication, and social context. Also to be attended to are the person of the clinician and the

family member.

Given the centrality of diagnosis for clinical care, advancing the goals of person-centered

psychiatry and medicine requires the development of a relevant diagnostic model. This paper

presents the conceptual bases and structure of one such model, Person-centered Integrative

Diagnosis (PID), including its health domains, descriptive tools, and evaluation process, and

considers the implications of PID for clinical care, prevention, health promotion and public

health as well as its future prospects.

Person-centered Medicine as an Evolving Paradigm

Historical Background

Many ancient and still practiced medical systems, for example Chinese and Ayurvedic,

involve a broad concept of health and personalized approaches to clinical care and health

promotion [1]. In these systems of medicine, a personalized approach is manifested in the way

that practitioners follow the bodily state and the experience of the patient from visit to visit and

adjust treatment accordingly [2]. A similar view can be found in the historical roots of Western

medicine. Ancient Greek philosophers and physicians advocated a holistic approach [3].

Socrates, for example, stated that “if the whole is not well it is impossible for the part to be well”

[4]. Such encompassing Eastern and Western views are consistent with the World Health

Organization’s [5] broad definition of health as a complete state of physical, emotional, and

social well being, and not merely the absence of disease.

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Despite this well established definition of health, modern medicine has become strongly

disease-focused and organ specific. Clinicians’ focus on symptoms and signs of disease often

undermines attention to patients’ values and experiences of suffering as well as to their

resilience, resources, quality of life and other aspects of positive health. Along with advances in

the scientific study of pathophysiology and exciting new diagnostic and treatment technologies,

biomedicine has brought extreme specialization and an ensuing fragmentation of services, rigid

compartmentalization and uncontrolled commoditization of the health care field, resulting in

neglect of patients’ particular needs and concerns, and weakening of the doctor-patient

relationship [6].

Clinical and Public Health Developments

Several important clinical developments have been seeking to address these imbalances

or distortions in biomedicine. Family physicians have adopted a holistic and contextualized

patient-centered approach [7]. Rogers [8] persuasively argued for the value of open

communication and empowering individuals to achieve their full potential. Research in clinical

communication promises major contributions to more effective and personalized care [9, 10].

The narrative-based medicine approach argues for the importance of understanding patients’

illness experience in the context of their life stories and current illness narratives [11, 12, 13].

Alanen [14] and colleagues in Finland developed a need-adaptive assessment and treatment

approach, which encourages attention to the meaning of patients’ experiences and to the nature

of their needs. The recovery movement [15, 16, 17] which started in the rehabilitation field

through the efforts of patient/user groups and like-minded clinicians, attempts to go beyond the

focus on symptom management and functional improvement to promote wellness and quality of

life, in a process that involves shared decision-making, and where the needs of the patients

always come first. The values-based practice advocated by Fulford and colleagues [18] and the

multilevel explanatory schemas presented by philosopher of science and medicine Schaffner [19,

20] are contributing to a renaissance of philosophical analysis in psychiatry aimed at addressing

the complexity of illness experience and engaging the patient as a person. Integrating many of

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the above developments, the fundamental importance of personhood in general medicine [21]

and in psychiatry and mental health [22] has been highlighted.

Along with these clinical and conceptual developments, major national and international

health policy statements have argued for greater attention to the totality of the person in clinical

care and to the integration of health and social services. A patient-centered “medical home”

model, which aims to provide comprehensive primary care and facilitate partnerships between

individual patients and their physicians and, when appropriate, the patient’s family, was

developed in 1967 by the American Academy of Pediatrics and endorsed later by the American

Academy of Family Physicians and a growing number of national health professional

associations [23, 24]. The president of the American Academy of Family Physicians [25]

recently has suggested that the focus of the medical home be shifted from “patients” to “persons”

to promote the empowerment and responsibility of persons as well as flexibility and creativity in

health care.

In a landmark study, the Institute of Medicine [26] concluded that the U.S. health system

was seriously flawed and requires a new framework with a new set of aims and rules, a key

principle being person-centeredness. Along the same lines, the U.S. Presidential Commission on

Mental Health [27] found the national mental health care system in a state of disarray and

proposed a thorough transformation of the system to be driven by the patient and the community.

The World Health Organization European Office [28] proposed an Action Plan to reorganize

mental health care around the needs of patients and carers. The United Kingdom Department of

Health [29] has developed a national policy for shared vision in diagnostic understanding and

carrying out health actions as a partnership of patients, carers and clinicians to address and

promote the totality of the person.

Contributions from Major Professional Organizations

The World Medical Association’s (WMA) ethical frame of reference emphasizes the

rights of individuals in need of health care (www.wma.net/policy). The triad of caring, ethics and

science has been reaffirmed as the enduring bases of the medical profession [30] with the

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consequent obligation to respect human life rather than blindly extend it [31]. The World

Organization of Family Doctors (Wonca) has adopted a holistic perspective [32] and recorded its

long-term commitment to persons and community in its basic concepts and values. Implementing

these ethical codes and values require systematic attention to the lived experience and quality of

life of patients.

As documented by Garrabe [33], the World Psychiatric Association (WPA) from its

inception has been interested in the articulation of science and humanism and in psychiatry for

the person. In 2005, the WPA’s General Assembly established an Institutional Program of

Psychiatry for the Person, which proposed the whole person in context as the center and goal of

clinical care and public health, and endorsed Ortega y Gasset’s dictum “I am I and my

circumstance” [34].

More recently, the World Medical Association (and several world medical specialty

associations), the World Health Organization, the World Federation for Mental Health (which

includes psychiatrists, patients, families, and mental health advocates), the International Alliance

of Patients’ Organizations, the International Council of Nurses, the International Federation of

Social Workers, the International Pharmaceutical Federation, the World Federation for Medical

Education, and the International Federation of Medical Students’ Associations, among others,

have organized Geneva Conferences on Person-centered Medicine in 2008, 2009 and 2010.

These events have led to a monograph on conceptual explorations on person-centered medicine

[35]. Concurrent with these developments, the latest World Health Assembly [36] approved a set

of resolutions that for the first time focuses attention on promoting people-centered care.

Emerging from the Geneva Conferences multi-institutional and collegial collaboration

process, an International Network for Person-centered Medicine has been established to

coordinate the further development of the initiative. It conceives person-centered medicine as

dedicated to the promotion of health as a state of physical, mental, socio-cultural and spiritual

wellbeing as well as to the reduction of disease, founded on mutual respect for the dignity and

responsibility of each individual person, with a vision of a medicine of the person, for the person,

by the person, and with the person [37, 35].

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Fundamental Diagnostic Concepts and Procedures

Meanings and Purposes of Diagnosis

The conventional purpose of medical diagnosis is to characterize the nature of a specific

disease or disorder and distinguish it from other conditions. In so doing, diagnosis may help to

elucidate potential causes, underlying mechanisms, and likely course and to plan appropriate

treatment. This role of diagnosis has been highlighted by Feinstein [38] who noted that diagnosis

provides the location where clinicians store the observations of clinical experience and guides

how clinicians observe, think, remember, and act.

Exploring the fullness of the diagnostic concept, the eminent historian and philosopher of

medicine Lain Entralgo [39] cogently argued that diagnosis goes beyond identifying a disease

(nosological diagnosis) to also involve understanding of what is going in the body and mind of

the person who presents for care. Understanding an individual’s clinical condition also requires

a broader assessment of experience and life context. As health may be conceived as a person’s

capacity to continue to pursue his or her goals in an ever-challenging world [40], this

encompassing perspective should be incorporated in a thorough diagnosis of health. Diagnostic

understanding also requires a process of engagement and empowerment that recognizes the

agency of patient, family and health professionals participating in a trialogical partnership [41].

Further to this conceptual shift, epidemiological surveys and increasing attention to prevention

and health promotion require a broadened role and scope of diagnosis to serve as an

informational basis for public health.

As a crucial step in the clinical process, diagnosis has a number of substantial goals

including identification of illness, communication among clinicians and other users, planning

care and treatment interventions, facilitating research on mechanisms of pathophysiology,

healing and recovery, clinical education and training, and prevention and health promotion.

Diagnostic systems and methods have been evolving to fulfill these diverse goals. For example,

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to enhance communication among clinicians, psychiatric diagnosis needs to be clear and

reproducible; this has provided the impetus to develop rule-based classifications with explicit

inclusion and exclusion criteria for psychiatric disorders, which have facilitated clinical research

as well as large epidemiological surveys [42].

The concept of validity of diagnosis denotes its value and usefulness. Traditionally, this

validity has been anchored on the faithfulness and accuracy with which a diagnosis reflects and

identifies a disorder, its nature, pathophysiology and other biomedical indicators [43]. Recently,

clinical utility has been proposed as an additional indication of the value of diagnosis for clinical

care [44, 45]. Schaffner [20] has delineated further the epistemology of these two forms of

diagnostic validity under the terms of etiopathogenic and clinical validities. Pointing out the

significance of the latter, experienced clinicians suggest that treatment planning is the most

important purpose of diagnosis [46]. And planning of treatment and recovery is further

recognized as a key lever of transformative change in personal and health systems [47].

Diagnosis Structure and Dynamic Interactions

The architecture of diagnosis has also been evolving in order to meet the goals of

diagnosis and clinical care. Thus, there has been a progressive development of diagnostic

schemas with increasing levels of informational richness from a simple, typological single-label

diagnosis denoting a symptom, problem, syndrome, or illness to more complex multiple illness

formulation, listing all identified clinical conditions or disorders, including coexisting psychiatric

and general medical diseases. Such schemas provide a fuller portrayal of the nosological

condition, as well as, in some cases, disabilities, contextual factors, and quality of life, thus

promoting diagnostic understanding, treatment planning and prognostic determination [48, 49].

Multiaxial diagnostic formulations are key components of current diagnostic systems including

ICD-10 [50, 51], DSM-IV [52], GLADP [53], GC-3 [54], the French Classification for Child and

Adolescent Mental Disorders [55], and the Chinese Classification of Mental Disorders (CCMD-

3) [56].

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A broad understanding of a clinical condition must be open to consider the interactive

aspects of a biopsychosocial framework. For example, different biological systems seem to be

involved in the regulation of physical and psychosocial processes as well as in self aware

creativity reflecting mankind’s long evolutionary history [57]. Human beings have different

systems of learning for habits and skills, for facts and propositions, and for intuitions and

autobiographical narratives in self-awareness [58]. The complexity of human development must

be understood within each individual’s unique genetic and cultural inheritance and the ongoing

narrative of his or her life experiences [59].

There are compelling reasons for including health-promoting or salutogenic factors [60]

and positive health [61] under comprehensive diagnosis, bringing it to consistency with WHO’s

definition of health. To be noted, the determinants of illnesses and the determinants of wellbeing

are not always the same, though they tend to be interrelated [62, 63, 64, 65]. Comprehensive

diagnosis must also serve the evolving integration of clinical medicine and public health.

Addressing the global burden of chronic non-communicable disorders attributable to lifestyle

factors will require such integration and may be implemented by bringing more targeted

personalized approaches to public health and more positive-health community views to clinical

care [66, 67].

The Development of the Person-centered Integrative Diagnosis (PID) Model

Early Work

More than a decade ago, building on an evolving tradition, the Section on Classification,

Diagnostic Assessment and Nomenclature of the World Psychiatric Association (WPA)

facilitated the study and development of comprehensive and person-centered diagnostic models.

This led to the implementation and publication of a major WPA-WHO Survey on the Use of

ICD-10 and Related Diagnostic Systems [68] and two monographic issues of Psychopathology

(the Section’s official organ), one on International Classification and Diagnosis: Critical

experience and Future Directions [69] and another on Philosophical and Methodological

Foundations of Psychiatric Diagnosis [70].

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On the basis of the results of the above-mentioned survey and similar international

consultations, a WPA Classification Section group developed and published the WPA

International Guidelines for Diagnostic Assessment (IGDA) [71]. At the core of these Guidelines

there is a comprehensive diagnostic schema that integrates a standardized multiaxial formulation,

employing scales and official typologies yielding information comparable across the world on

illnesses, disabilities, contextual factors and quality of life, and an idiographic, personalized

statement allowing clinicians, patients and families to indicate what is unique and most

meaningful in the contextualized clinical situation, including positive factors, as well as joint

plans for restoration and promotion of health. The IGDA diagnostic model has been utilized in a

variety of countries, including several in Latin America, leading to its incorporation into the

Latin American Guide for Psychiatric Diagnosis [53], and to published reports that the IGDA

model brings the whole person of the patient to the foreground of clinical work [72].

The WPA Classification Section undertook in the past triennium a critical review of

broad health concepts, specific disorders, comorbidity and prospective diagnostic models that led

to the publication of Psychiatric Diagnosis: Challenges and Prospects [73]. This work is now

being extended in collaboration with colleagues in several world medical and health

organizations under the aegis of the International Network for Person-centered Medicine.

Recently, the views of psychiatrists and other health professionals as well as other health

stakeholders such as patients, families and advocates have been explored on concepts and

strategies for the development of improved diagnostic systems. Such consultations have included

a survey of a global network of national classification and diagnosis groups and focus or

discussion groups conducted at the World Federation for Mental Health Congress in Athens and

at conferences taking place in Uppsala, Sweden and Timisoara, Romania in September 2009

[46]. The main findings from these consultations include the perception that planning of

treatment and care (rather than illness identification or inter-clinician communication) is the

main purpose of diagnosis; the desirability of simplifying standard psychopathological

classifications through clusters and prototypes; and that diagnosis should cover not only

disorders but also disabilities, positive aspects of health, risk and protective factors, and the

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patient’s values and experience on illness and health. These consultations also supported the use

of dimensions and narratives in addition to categories as descriptive tools; and the importance of

basing the diagnostic process on an active partnership among clinicians, patients, and families.

These consistently expressed perspectives seem to strongly support a person-centered diagnostic

approach in contrast to the conventional disease-centered diagnosis.

The Fundamentals of the PID Model

The purpose of the Person-centered Integrative Diagnosis (PID) model is to facilitate and

optimize person-centered care based on the considerations discussed in the earlier sections of this

paper. Therefore, the development of PID must be oriented by the major principles of person-

centered psychiatry and medicine such as articulation of science and humanism, elaboration of a

biopsychosocial theoretical framework, covering both ill and positive aspects of health, ensuring

engagement, empathy and partnership in the clinical care process, and sustaining the patients’

autonomy, responsibility and dignity while advancing the restoration and promotion of their

health and quality of life. Furthermore, the development of the PID must take into account that

diagnosis is both a formulation and a process.

The presentation of the fundamentals of the PID model will be made in terms of the following

three defining conceptual pillars: a) Broad Informational Domains, b) Pluralistic Descriptive

Procedures, and c) Partnership for Evaluation.

The PID framework’s first pillar, Broad Informational Domains, is depicted in Figure 1. These

domains cover both ill health and positive health along three complementary levels: Health

Status, Experience of Health, and Contributors to Health.

[Insert Figure 1 here]

The broadness of the PID informational domains, including ill and positive health, is intrinsic to

holistic person-centered health care [60, 61, 62]. The domain level on Health Status, includes

first illnesses or disorders of both mental and physical forms, which correspond to Laín-

Entralgo’s nosological diagnosis [39]. They would be assessed according to the international

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standard, WHO’s International Classification of Diseases, or a pertinent national or regional

version or adaptation previously listed. Given the problems reported by psychiatrists with the

currently profuse number of mental disorder categories [46], simplification of their classification

is desirable and could be attempted through identifying clusters and summary prototypes [74, 75,

76]. Disabilities would be assessed through procedures such as those based on the International

Classification of Functioning and Health (ICF) [77]. The assessment of the wellbeing aspect of

Health Status would be explored through scales appraising quality of life and related constructs

[62, 78] .

The domain level on Experience of Health would appraise the patient’s illness- and health-

related values and cultural experiences, possibly with a guided narrative procedure built on

world-wide experience with the Cultural Formulation [79]. The third domain level on

Contributors to Health would cover a range of intrinsic and extrinsic biological, psychological

and social factors of both risk and protective types. Their assessment may involve a combination

of procedures aimed at assessing healthy and unhealthy life-style factors and related health

contributors [80, 81].

The PID model’s second defining pillar, Pluralistic Descriptive Procedures, opens up the

opportunity to employ categories, dimensions, and narratives for greater flexibility and

effectiveness for the evaluation task at hand [46, 76]. Categorization would not be of the

classical form (abstract and deterministic) but of a probabilistic or prototypic form (attributes not

being jointly necessary and sufficient, but only correlated with the corresponding category) [82],

as is being used progressively in diagnostic systems. In addition to its naturalistic perspective,

the use of prototypes offers the desirable possibility of organizing narrow disorder categories

into a parsimonious set of broader categories as well as accommodating the semi-quantitative

concept of goodness of fit and enabling the development of categorical-dimensional hybrid

models [74].

Diagnostic categorical labeling reduces the richness of clinical observation to a crude

dichotomy of the presence of absence of disease. The use of dimensions in general clinical

medicine was highlighted by Feinstein under the rubric of clinimetrics [83]. Their graded

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quantitative nature allows a more effective retention and use of systematic clinical information

[76]. Their adoption for regular diagnostic work requires careful consideration [84].

Regardless of the quality of available standardized tools, a narrative component to diagnostic

assessment is fundamental, as health care is, to a great extent, grounded in subjective experience.

Canguilhem’s [40] conceptualization of the pathological encourages us to understand the

intricate vicissitudes of the life of a particular patient. The person’s illness narrative and account

of health and resilience offers the clinician a clear picture of issues and priorities that can

organize and guide clinical intervention [12]. Many clinicians and other health stakeholders are

calling for the complementary use of narratives in diagnostic assessment [46].

The third defining pillar of the PID model is Partnership for Evaluation. Such partnership is a

fundamental element of person-centered care, and involves the pursuit of engagement, empathy

and empowerment as well as respect for the autonomy and dignity of the consulting person. In

fact, it is crucial for achieving shared understanding for diagnosis and shared decision making

for treatment planning [29]. The PID model encourages the clinician’s self-reflexive attention to

the interaction with the patient and others in their entourage and an appraisal of the systemic

processes affecting the collection of health information and its subsequent use.

In many cultures, the notion of the person includes relationships to others in the family and

community [85]. The value of triadic interactions and partnerships among patients, families and

clinicians has been studied by Amering [41] and appears to be increasingly accepted by health

professionals and other stakeholders [46]. Of course, a central relationship for clinical care

within such partnerships remains that between clinician and patient [86, 87]. Its implications and

power relations can be usefully analyzed through approaches such as Pratt and Zeckhauser’s [88]

principal-agent theory. At the other end of the partnership spectrum is the inclusion of

community representatives such as teachers, which is often crucial in the diagnostic assessment

of children [89].

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Further Development and Evaluation of Person-centered Integrative Diagnosis

The next step in the development of PID will be the construction of a practical guide to

its clinical implementation. This will involve the operationalization of the conceptual model as a

set of guidelines and procedures for practical use. First, a PID Guide draft with enough detail for

clinical application will be prepared. It will also identify the procedures to be employed for the

appraisal of the key components of PID. The PID Guide draft will be evaluated through field

trials across different clinical settings. These will appraise the clinical feasibility, reliability, and

validity of the Guide. Based on the results of the evaluation process, and on discussions with

clinicians and other stakeholders, a final version of the PID guide will be produced. Eventually,

the PID Guide will be translated into multiple languages and training aids will be developed.

Procedures for promoting and monitoring its use will be established as well, to maximize its

value in clinical and public health settings.

Concluding Remarks

Person-centered Integrative Diagnosis (PID) is inscribed within a paradigmatic broad effort to

place the whole person at the center of medicine and health care. The structure of the PID

model involves the broadening of the scope of diagnosis to cover both the ill and the positive

aspects of health, in terms of its status, experience, and contributory factors. It utilizes to this

effect not only conventional categorization but also dimensions that allow greater retention and

use of quantitative information, and narratives that allow deeper exploration of meaning and

consideration of personal feelings and values. Through empirical research and stakeholder

consultations a PID practical guide will be developed and evaluated, to be followed by efforts to

promote its implementation, professional training, and monitoring of use, and to lead to more

person-centered clinical care and people-centered public health.

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Figure 1. Person-Centered Integrative Diagnosis Domains

ILL HEALTH POSITIVE HEALTH

I. HEALTH STATUS

Illness & its Burden

a. Disorders

b. Disabilities

Well Being

Recovery/Wellness

Functioning

II. EXPERIENCE OF HEALTH

Experience of Illness

(e.g. suffering, values,

understanding and meaning of illness)

Experience of Health

(e.g. self-awareness, resilience,

fulfillment )

III. CONTRIBUTORS TO HEALTH

Contributors to Illness

(intrinsic/extrinsic; biological,

psychological, social)

Contributors to Health

(intrinsic/extrinsic; biological,

psychological, social)