international journal of person centered ......2011 subscription prices are: institutional us$ 200...

ISSN 2043 7730 www.ijpcm.org

Volume 1 No 1 March 2011

INTERNATIONAL JOURNAL OF

PERSON CENTERED

MEDICINE

Editor-in-Chief Andrew Miles

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INTERNATIONAL JOURNAL OF PERSON CENTERED MEDICINE

Deputy Editor-in-Chief Juan E. Mezzich

Table of Contents Volume 1 Issue 1 2011 Editorial Introduction 1 Advancing the global communication of scholarship and research for individualised healthcare: the International Journal of Person Centered Medicine Andrew Miles and Juan E. Mezzich Third Geneva Conference on Person-Centered Medicine Part One 6 Introduction to the Third Geneva Conference on Person-Centered Medicine: Collaboration across specialties, disciplines and programs

Juan E. Mezzich and Andrew Miles Conceptual Perspectives 10 Building Person Centered Medicine through Dialogue and Partnerships Juan E. Mezzich 14 African Approaches to an enriched ethics of person-centred health practice Werdie (CW) Van Staden The Team Approach in Person-centered Health Care 18 Person Centered Medicine and the Primary Care Team – securing continuity of care Annemarie Uijen, Henk Schers and Chris van Weel 20 Nurses and Person- Centred Care Tesfamicael Ghebrehiwet 23 The Team Approach in Person-Centred Health Care: The Social Work Perspective Terry Bamford Person-centered Basic Communication Skills 27 What makes them (not) talk about proper medication use with their patients? Sandra van Dulmen, Evelien van Bijnen 35 Best Evidence Teaching of Person-centred Basic Communication Skills: a reflection E.M. van Weel-Baumgarten and M.H. Brouwers Person-centered Clinical Care Activities 39 Conceptual Appraisal of the Person-centered Integrative Diagnosis Model Ihsan M Salloum and Juan E. Mezzich 43 Person-centered Therapeutics C. Robert Cloninger and Kevin M. Cloninger 53 Person Centred Medicine for the Older Patient, with Specific Reference to the Person with Dementia Jon Snaedal Cultural Diversity and Person-centered Health Care 56 Culture, Ethics & Medicine in South Asia Roy Abraham Kallivayalil and Rakesh K Chadda 62 Person centered care and Economic Deprivation: an epidemiological view of positive mental health in a less-developed country Javier

E. Saavedra, Victor Cruz, Juan E. Mezzich 75 Person Centered Care and Gender Diversity Islene Araujo de Carvalho Special Initiatives for Person-centered Care 78 Person Centered Medicine Theory, Teaching And Research Giuseppe R. Brera 89 International Federation of Medical Students Association: views on Person-Centered medicine Remco Kruithof, 91 The World Federation for Mental Health (WFMH) – International Network for Person-Centered Medicine (INPCM) Project: Mental Health

as a Priority: Adopting a Holistic Approach to Patient Care Helen L Millar and Mohammed T Abou-Saleh 97 Person Centered Medicine and the Perspective of the International Federation of Gynaecology and Obstetrics – the example of screen-

ing for chromosomal anomalies in pregnancy Wolfgang Holzgreve 100 Bulgarian Person Centered Public Health Project Jeliazko Hristov, Drozdstoj S. Stoyanov, Bianka Tornjova and Donka Dimitrova 104 Person-centred Psychodynamic Perspectives Margit Schmolke 108 Developing an International Network of Person Centered Medicine Informational Base and Bibliographical Clearinghouse Levent Kirisci,

Maureen Reynolds, Michael Vanyukov, Ty Ridenour, Jeanine Hayes and Juan E. Mezzich In Review 111 Tailoring care to individuals and populations within resource-poor settings: A review and commentary on the World Health Organisa-

tion Report People-Centred Care in Low and Middle Income Countries A Miles Special Section: Conceptual Bases of Psychiatry for the Person 117 Forewords 119 Introduction to the Conceptual Bases of Psychiatry for the Person Juan E. Mezzich, George Christodoulou and K.W.M. Fulford 123 Historical Views on Psychiatry for the Person Jean Garrabe and Paul Hoff 126 Philosophy of Science Perspectives on Psychiatry for the Person Tim Thornton and Kenneth F. Schaffner 128 Values and Ethics Perspectives on Psychiatry for the Person KWM Fulford, George Christodoulou and Dan Stein 131 Psychological Perspectives on Psychiatry for the Person Michel Botbol, Yrjö O. Alanen, Dusica Lecic Tosevski and Margit Schmolke 134 Biological Perspectives on Psychiatry for the Person C. Robert Cloninger , Mohammed Abou Saleh, David A. Mrazek, Hans-Jürgen Möller 137 Social Perspectives on Psychiatry for the Person Wolfgang Rutz, Manuel Fernandez and Jitendra Trivedi 140 Ethnomedical and Cultural Foundations of Psychiatry for the Person Horacio Fabrega Jr and Ronald Wintrobb 143 Spirituality, Religion and Psychopathology: Towards an integrative psychiatry John Cox and Peter J. Verhagen 146 Literature and the Arts Perspectives on Psychiatry for the Person Ekaterina Sukhanova, Hans-Otto Thomashoff and Yves Thoret 148 Service User and Family Perspectives on Psychiatry for the Person Jan Wallcraft, Sigrid Steffen and Michaela Amering Regular Articles 151 Measuring Family Centred Care: Working with Children and Their Parents in a Tertiary Hospital Linda Shields, Abdulla A. Mamun, Sandra

Pereira, Pam O'Nions and Gervase Chaney 157 The role of patient management in medical expertise development: Extending the contemporary theory Alireza Monajemi and Remy

M.J.P. Rikers 163 Care requirements of patients with advanced cancer within a specialist centre – moving to person-centered approaches Donna Milne,

Lisa Sheeran, Tracey Dryden, Linda Mileshkin and Sanchia Aranda 173 Comparing breast and lung cancer patients’ experiences at a UK Cancer Centre: implications for improving care and moves towards a

person centered model of clinical practice Elizabeth A Davies, Peter Madden, Victoria H Coupland, Mairead Griffin, and Alison Richardson 186 Medicine And Spirituality: The role of love in the therapeutic process of HIV/AIDS sufferers in an African village Andrew Lightbown and

Nicholas Fane 192 Person-centred care: Bridging current models of the clinician-patient relationship Stephen Buetow


Editor-in-Chief Professor Andrew Miles

Medical School, University of Buckingham

Deputy Editor-in-Chief Professor Juan Mezzich

Mount Sinai School of Medicine, New York University

North America C. Robert Cloninger Latin America Raul Leon-Barua

Regional Editors Europe Chris van Weel Africa Werdie (CW) van Staden Statistical Editor

Asia Yongyuth Pongsupap Oceania Stephen Buetow

Mohammed Abou-Saleh Azman Abu Bakar Neal Adams Yrjo Alanen Anne-Francoise Allaz Michaela Amering James Appleyard Olayinka Ayankogbe Terry Bamford Claudio Banzato Claudia Bartz Antoine Besse Michel Botbol Giuseppe Brera Luis Caravedo Eric Cassell Rita Charon George Christodoulou John Cox Ted Epperly

Levent Kirisci Editorial Board Arnstein Finset Patt Franciosi Bill Fulford Elena Gayvoronskaya Tesfamicael Ghebrehiwet Joanna Groves Wolfgang Holzgreve Roy A. Kallivayalil Marianne Kastrup Yvonne Kayiteshonga Simon-Daniel Kipman Laurence Kirmayer Michael Klinkman Zorayda E. Leopando Wim Van Lerberghe Michael Loughlin Marion Lynch Jan De Maeseneer Roger Montenegro Hans-Juergen Moeller Jeremiah Mwangi

Oscar Pamo Salman Rawaf Bernard Ruedi Wolfgang Rutz Javier Saavedra Ihsan Salloum Luis Salvador-Carulla Kenneth Schaffner Margit Schmolke Tom Sensky Jon Snaedal Drozdstoj Stoyanov Ekaterina Sukhanova Ralph Tarter Tim Thornton Jitendra Trivedi Michel Vallotton Sandra van Dulmen Eugenio Villar Janet Wallcraft

Information for Subscribers The International Journal of Person Centered Medicine is published quarterly. ISSN Print 2043 7730 ISSN Online 2043 7749 www.ijpcm.org 2011 Subscription prices are: Institutional US$ 200 Personal US$ 100 Prices do not include delivery or postage or taxes where applicable. Publisher The International Journal of Person Centered Medicine is published by: The University of Buckingham Press Ltd., Yeomanry House, Hunter Street, Buckingham MK18 1EG UK Tel: +44 (0)1280 828338 Email: [email protected] The International Journal of Person Centered Medicine is published as a joint venture between the International Network for Person Centered Medicine and the University of Buckingham Press.

Aims and Scope The International Journal of Person Centered Medicine (IJPCM) is dedicated to the development of the theory and practice of Person-Centered Medicine (PCM). All aspects of PCM and multi-disciplinary person-centered clinical care are therefore of interest to the Journal, particularly: (a) medical epistemology and the nature of knowledge for the individualisation of clinical practice; (b) reductionism and complexity in clinical care; (c) methodologies for the individualisation of clinical practice and for the evaluation and development of person-centred medicine; (d) methodologies for the development, use and evaluation of person-centered history taking, diagnosis, prognosis and follow-up; (e) clinical practice recommendations and guidelines for PCM; (f) narrative-based medicine; (g) values-based medicine; (h) transcultural medicine; (i) psychosocial and psychosexual medicine; (j) social and environmental care in PCM; (k) spiritual and religious care; (l) economic aspects of PCM and policies for the funding of PCM; (m) individualised/personalised (genomic) medicine; (n) sociological aspects of PCM; (o) the medical humanities and PCM; (p) ethical and medico-legal implications of PCM; (q) the role of the family and of friends in caring and decision making; (r) the development and use of information technology and medical informatics for the development, application and evaluation/audit of PCM; (s) person-centred design and operation of healthcare facilities; (t) health service policies and policy-making for PCM; (u) the national and international health politics of PCM, (v) the role of medical education and PCM & (w) people-centred care (population approaches to clinical care). The Journal welcomes learned submissions from doctors, nurses, the allied professions and all those clinical and non-clinical colleagues with an interest in, or responsibility for, the development and application of person-centred approaches to clinical care and public health

Disclaimer The Publisher and Editors can not be held responsible for errors or any consequences arising from the use of information contained in this journal; the views and opinions expressed do not necessarily reflect those of the Publisher and Editors, neither does the publication of advertisement constitute any endorsement by the Publisher and Editors of the products advertised.

Press release

The International Journal of Person Centered Medicine The International Network for Person Centered Medicine (INPCM) and the University of Buckingham Press are delighted to announce the publication of the first issue of their joint venture journal - The International Journal of Person Centered Medicine (IJPCM). The journal will be available in print and online at www.ijpcm.org. INPCM is the leading educational, research, and advocacy organization in this field and the journal looks set to establish itself as a landmark publication of major importance to the world medical and health organizations. The first issue of this quarterly journal will be published at the end of March 2011 and contains papers from Third Geneva Conference on Person-centered Medicine and the Conceptual Bases of Psychiatry for the Person as well as other articles. The IJPCM is launched when the importance of PCM is gaining ever-greater recognition.Though science, ethics and care are the enduring traditions of the medical profession, it is PCM, in attending to the whole person and the biological, psychological, social and spiritual aspects of health which unifies these strands. Significantly, the WHO is now placing people/person at the centre of healthcare and public health, and has started discussions on adding the dimension of spirituality. The Editorial Board of this important international Journal is drawn from all major medical specialities and health disciplines and is constituted by the world’s most distinguished thinkers in the field. Regional Editors have been appointed for North America, Latin America, Europe, Africa, Asia, and Oceania Professor Andrew Miles said: ‘The IJPCM, creating as it does an international forum for the exchange of ideas and the promotion of scholarly debate, is an extremely important contribution to the advancement and operationalisation of humanistic medicine in our times. I am honoured to be invited to be the inaugural Editor-in-Chief at this exciting time of paradigmatic change within medicine. I recommend the journal as essential reading for all clinicians and trainees and to all those academic disciplines with an interest in or responsibility for the promotion of person and people-centered medicine’. For more information please contact: Editorial Andrew Miles, Editor in Chief of the International Journal for Person Centered Medicine Professor of Clinical Epidemiology and Social Medicine, University of Buckingham, United Kingdom. [email protected] The Network Juan Mezzich, Deputy Editor in Chief of the International Journal for Person Centered Medicine President, International Network for Person Centered Medicine Professor of Psychiatry, Mount Sinai School of Medicine, New York University [email protected] Publishing Christopher Woodhead The University of Buckingham Press [email protected]


Deputy Editor-in-Chief Professor Juan Mezzich

Editor-in-Chief Professor Andrew Miles

Oceania Professor Stephen Buetow

North America Professor C. Robert Cloninger

Africa Professor C Werdie van Staden

Europe Professor Chris van Weel

Latin America Professor Raul Leon-Barua

Asia Professor Yongyuth Pongsupap

Regional Editors

Statistical Editor Professor Levent Kirisci

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Mahommed Abou-Saleh Azman Abu Bakar Neal Adams Yrjo Alanen Anne-Francoise Allaz

Michaela Amering James Appleyard Olayinka Ayankogbe Terry Bamford Claudio Banzato

Claudia Bartz Antoine Besse Michel Botbol Guiseppe Brera Luis Caravedo

Eric Cassell Rita Charon George Christodoulou John Cox Ted Epperly

Arnstein Finsett Patt Franciosi Bill Fulford Elena Gayvoronskaya Tesfamicael Ghebrehiwet

Joanna Groves Wolfgang Holzgreve Ray A Kallivayalil Marianne Kastrup Yvonne Kayiteshonga

Simon-Daniel Kipman Laurence Kirmayer Michael Klinkman Zorayda Leopando Wim van Lerberghe

Michael Loughlin Marion Lynch Jan de Maeseneer Roger Montenegro Hans-Jurgen Moeller

Jeremiah Mwangi Oscar Pamo Salman Rawaf Bernard Ruedi Wolfgang Rutz

Javier Saavedra Ihsan Salloum Luis Salvador-Carulla Kenneth Schaffner Margit Schmolke

Tom Sensky Jon Snaedal Drozdstoj Stoyanov Ekaterina Sukhanova Ralph Tarter

Tim Thornton Jitendra Trivedi Michel Vallotton Sandra van Dulmen Eugenio Villar

Janet Wallcraft

INTERNATIONAL JOURNAL OF PERSON CENTERED MEDICINE Editorial Board

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The International Journal of Person Centered Medicine

1 The International Journal of Person Centered Medicine

Volume 1 Issue 1 pp 1-5

EDITORIAL INTRODUCTION

Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine

Andrew Miles MSc MPhil PhDa and Juan E. Mezzich MD MA MSc PhDb

a Editor-in-Chief, International Journal of Person Centered Medicine, Professor of Clinical Epidemiology and Social Medicine, Medical School, University of Buckingham, UK b Deputy Editor-in-Chief, International Journal of Person Centered Medicine, Professor of Psychiatry, Mount Sinai School of Medicine, New York University, USA, President, International Network for Person-centered Medicine

Correspondence address Prof. Andrew Miles, Director, Centre for Clinical Epidemiology and Social Medicine, P. O. Box 64457, London SE11 9AN, UK. E-mail: [email protected] Accepted for publication: 29 March 2011

Introduction

A simple Google search using the phrase ‘The Foundational Philosophy of Medicine’ yields 1,510,000 results. If one omits the word ‘Foundational’, then the search result yields 11,900,000 items. Certainly, much material of varying scholarship and complexity has been written over the course of two millennia on this very particular subject, not all of which is immediately accessible, not even through Google. Yet the fundamental philosophy of medicine can also be articulated very simply and indeed has been and in the following few words: ‘to cure sometimes, to relieve often, to comfort always’. Originally attributed to Hippocrates, this striking maxim has become more closely associated in recent times with Edward Livingstone Trudeau, a nineteenth Century physician who, retiring to Saranac Lake in the Adirondack mountains of New York in order to palliate his tuberculosis, founded several important health facilities during his remaining lifetime which continue in existence today.

In our more modern times, the original maxim must surely be prefaced with ‘To prevent illness where possible’ and may also come with time to be concluded with: ‘To assist death when necessary’. If we accept the imperative for the former as universally established (the latter remaining the subject of intensive ongoing ethical, legal and emotional debate), then are we able to say that modern medicine fulfils these four conceptually different, though highly interrelated missions? It would be difficult, in our view, to answer correctly and honestly in the affirmative. Certainly, since Fleming’s discovery of penicillin in 1928 and the publication of the science

underlying the clinical use of radiation by Marie Curie for which she achieved the Nobel Prize in Physics in 1903 and for Chemistry in 1911, there have been staggering advances in pharmacotherapeutics and medical technology that have revolutionised the scope, possibility and power of clinical practice. Yet despite such unprecedented and astonishing progress, it would be difficult to deny that modern medicine has not entered into crisis: a crisis of caring, a crisis of compassion and a crisis of costs. Indeed, the perception that major distortions have occurred in the understanding of the purpose of modern medicine [1], has been accompanied by much soul searching, leading Miles, in an address to La Sapienza at Rome, to pose three distinct and initially startling questions: ‘What is Medicine for?’ ‘Where has Medicine gone wrong? ‘What can we do to put Medicine right again?’[2].

In our view, it is not the case that modern medicine is ineffective (although its limitations have become starkly exposed in the treatment of chronic conditions which now pose one of the greatest challenges to global economics and wellbeing), but rather that it has become depersonalised The purpose of this Editorial Introduction and the space allocated to it, do not allow a full exposition of our reasoning at the time of writing, though this will be made in extensive detail within the next issue [3] and very soon elsewhere [4,5]. Suffice it is here to advance our contention that the crisis in medicine is worsening, not improving and that the institution of a new periodical specifically dedicated to the development of a higher level of personalisation of clinical services than that which currently exists, is therefore not only timely, but urgently necessary, if medicine is to regain many of the fundamental characteristics of humanity and

Miles and Mezzich




professionalism that it has progressively lost over a century of empiricism, scientism and technocratic reductionism in health care [2, 6,7]. It is these observations and arguments which constitute, then, the primum movens for the conception and launch of the International Journal of Person Centered Medicine (Int J Pers Cent Med; IJPCM: www.ijpcm.org), the official journal of the International Network for Person Centered Medicine (INPCM) (www.personcenteredmedicine.org).

Scholarly interchange in PCM. To date, the international communication of ideas in person-centered medicine (PCM) has taken various forms, principal among them the publication of articles of varying nature and focus in specialty and subspecialty medical journals and within the periodicals of related clinical and academic disciplines. However, many of these journals are overloaded with manuscripts and are associated with long delays in the publishing process. In addition, many are preferentially concerned with experimental medicine, often appearing less interested in the innovations in clinical practice that are designed directly to increase patient and clinician satisfaction with care and the generation of enhanced clinical outcomes using currently available knowledge. The IJPCM does not intend to redirect the publication of PCM and PCM-related articles within the existing medical literature, despite the limitations we detail, but rather aims to complement and augment specialty publication by adding a distinctive and powerful voice to general discourse in the field and to methodological development and evaluation of the effects of PCM in particular, vital functions to which we will return in some detail below.

Person-centered clinical practice and people-centered public health Despite its title, the IJPCM will not focus exclusively on the individual patient, decontextualized from his social setting. To do so would be highly erroneous and would justifiably lead to the Journal being accused of the very reductionism in modern health care that it seeks to reverse. On the contrary, the IJPCM recognises that individuals exist within their circumstances and that these circumstances involve the patient’s living with other individuals in Society as well as in his own internal milieu. For this reason, the Journal will be as concerned with people-centered public health (PeCPH) as it is with person-centered clinical practice. Here, we aim to make a very specific contribution to medical progress, by arguing that the design and development of impersonal public health strategies should move away from the utilitarian application of methodologically limited, biostatistically dominated studies conducted in epidemiological

subpopulations, towards a more humanistic model of care based on science and humanity, for the individuals who, together, collectively constitute the social communities in which they are born to live and in which, later, they will come to die.

Moving from concepts to practice: IJPCM and methodological progress Now that the philosophical basis of person-centered clinical practice and people-centered public health has been coherently described and that their relationship as entirely complementary and mutually reinforcing models of healthcare is increasingly well acknowledged, the time has come to move these clinical philosophies away from their current status as universally recognised conceptually optimal models of care to the status of operationally normative models of care. Here, the design and development of detailed methodologies aimed at translating PCM and PeBPH into routine clinical practice is of pivotal importance and has become an urgent international priority. To be sure, the challenges involved in doing so are formidable and should not be underestimated. They include not only the necessary realisation of core methodologies to enable operational implementation of PCM and PeBPH models of modern care, but also the design and operation of systematic audits aimed at the quantitative measurement as well as the qualitative description of improved health outcomes from PCM and PeBPH interventions. It is more than gratifying to note that this work has, in fact, already commenced. Indeed, of relevance here is the prominent example of the recently instituted INPCM-WHO Project on Developing Measures to Assess Progress Towards People-centered Care. The IJPCM looks forward to the publication of the results of this important initiative and to commissioning and considering for publication in its pages further such important work.

The need for the developments we detail is, certainly, of fundamental importance. Indeed, while it is by no means a dominant position, there are nevertheless those working within international health services research that view PCM as ’well meaning’, but disconnected from the operational realities of health services, where patients' demands meet economic constraints, insufficiencies of clinical time and manpower, coupled with the rationing of, or denial of access to, the benefits of therapeutic and technological advance. Here, the need for humanity in clinical practice seems increasingly viewed as entirely optional and begins to appear as something which can safely be consigned to the history of medicine. After all, some argue, medicine cared when it could not cure, but now that medicine can cure, does it really need to care? To us, this is an example, par excellence, and spectacularly so, of a false dichotomy and one capable of occasioning great violence to the historic mission and Hippocratic nature of




medicine – if, that is, Society allows it to continue unchecked. Likewise, there are those colleagues who view the reawakening of humanity in medicine in an age of major scientific advance as an anachronism at best or as a form of inappropriate, anti-science sentimentality at worst. The IJPCM views such cynicism, misunderstanding and lack of human insight and imagination as deeply disappointing, indeed positively alarming.

In its simplest description, to care for someone is to want and to do what is best for them. In this context, what is best for patients is to be treated as persons, not diagnostic codes or statistical units. Medicine has the unalterable imperative to care, comfort and console as well as to attenuate, ameliorate and cure. A preferential concentration on either care or cure, rather than on a search for a means of integrating both, risks the creation of an ethical and moral chaos in medicine that can only result in the maintenance of the crisis in clinical professionalism to which we have already made reference in outline above and which will, without hyperbole, prove a disaster for patients. It seems to us incontrovertibly clear from raised voices worldwide, that patients are no longer prepared to be 'dealt with' or 'processed' by technicians in applied bioscience, but rather to be attended by scientifically trained advocates who recognise their problems not only at an organic, but also at emotional, social and spiritual levels and who, in addition, then proceed through shared decision making to tailor treatment for the patient through a medicine of the person (of the totality of the person’s health, including its ill and positive aspects), for the person (promoting the fulfilment of the person’s life project), by the person (with clinicians extending themselves as full human beings, well grounded in science and with high ethical aspirations) and with the person (working respectfully, in collaboration and in an empowering manner through a partnership of patient, family and clinicians) [8-10]. The IJPCM is committed to urging such an understanding of medical philosophy, knowledge and action and we are confident that the ongoing paradigmatic shift towards personalisation – and the reengineering and reconfiguration of clinical services that it will necessitate – will, sooner rather than later, come to result in better care for all. This is not an ideology expressed as a vain hope, but rather as a statement of the energy and conviction with which the members of the Editorial Board of this journal and many of its readers are greatly infused.

Raising the international awareness of the IJPCM and promoting its use

If the IJPCM is to make the difference to healthcare which we hope it will and to which it is enthusiastically wed, then a key challenge during the infancy of the Journal will be the need to ensure the success of the advertising and marketing of the IJPCM, where the principal aims are continuously to raise the profile of the Journal and to

generate revenues in support of the growing work of the International Network itself. At the time of writing, we are actively considering the methods by which to achieve these aims, using the well established techniques of sales and marketing campaigns, as well as novel approaches. Relevant here, and complementing the annual Geneva Conference on Person-centered Medicine are the plans in gestation for an annually recurring programme of international PCM conferences commencing in 2012 and which are aimed at elucidating key methodologies for the development of person-centered models of care by specific disease and condition. These initiatives will also directly assist IJPCM advertising, since journal marketing information can easily be included in the extensive e-mail and postal advertising programme that will be necessary to achieve awareness of and attendance at the international conference programme series. It is anticipated that each conference will not only generate a specific and sponsored Supplement of the IJPCM which will function primarily as a major educational resource in describing what constitutes a PCM model of care for the given disease/condition (e.g. Diabetes, the whole range of solid tumours and haematological malignancies, HIV/AIDS, CF, MND, PD, MS, etc.), but that the conferences and their published IJPCM supplements will also generate a significant share of revenue for the INPCM through delegate fees and sponsorship agreements, the latter directly enabling the special Supplement to be made freely available as an Open Access document on-line.

It is also hoped that the various senior national and international professional bodies and scholarly associations actively associated with the support and progress of the annual Geneva Conferences will also assist the raising of journal awareness through their membership databases when sending routine e-mails to members and also through carrying details of the Journal on their respective websites. Moreover, social media such as Facebook and Twitter are also likely to prove useful in bringing a knowledge of the Journal to the attention of physicians, health professionals in practice and training, to health journalists and medical librarians and also to so-called expert patients and to the general public itself.

While we are clear that these campaigns will be conducted primarily in the developed world in the first instance in order to generate the revenue necessary to establish the Journal as a viable financial entity as quickly as possible, we wish to confirm our unequivocal commitment to ensuring early, subsequent access to the Journal in the libraries and public institutions of low and middle income countries as a vital and indispensable part of the global dissemination of important health data. For example, the IJPCM plans to make itself available, as resources allow, through the Research4Life Initiative (HINARI). This project, managed by the World Health Organisation in partnership with Yale University Library, is important, given that 3,300 public institutions in 108 eligible low and middle income countries benefit directly from the free or very low cost access to clinical and

Miles and Mezzich




scientific journals via its work. Relevant here too is the IJPCM’s intention to become part of the PERii initiative (Programme for the Enhancement of Research Information) of the International Network for the Availability of Scientific Publications (INASP). Further plans involve, in addition, joining the Emergency Access Initiative (EMI), a partnership of the National Library of Medicine, the National Network of Libraries of Medicine and the Professional/Scholarly Publishing Division of the Association of American Publishers, which ensures free access to journal content in the wake of natural disasters and in times of humanitarian crisis. Furthermore, we aim to make journal content that is at least one year old available to small and/or specialist libraries that lack the resources necessary to purchase a full subscription, via the EBSCOhost databases. In terms of bibliometrics, a high impact factor and a healthy citation rate will develop naturally as the IJPCM progresses from infancy to adolescence, rising in international stature and importance as part of this process.

Aims and scope of the IJPCM and Editorial Governance

Person-centered Medicine is a broad field of study. It draws on the knowledge base of all of the medical specialties, health professions and on the scholarship and research of a wide variety of academic disciplines. The interests of the IJPCM are therefore correspondingly broad, but centre particularly upon core areas of study such as: (a) medical epistemology and the nature of knowledge for the individualisation of clinical practice; (b) reductionism and complexity in clinical care; (c) methodologies for the individualisation of clinical practice and for the evaluation and development of person-centred medicine; (d) methodologies for the development, use and evaluation of person-centered history taking, diagnosis, prognosis and follow-up; (e) clinical practice recommendations and guidelines for PCM; (f) narrative-based medicine; (g) values-based medicine; (h) cultural medicine; (i) psychosocial and psychosexual medicine; (j) social and environmental care in PCM; (k) spiritual and religious care; (l) economic aspects of PCM and policies for the funding of PCM; (m) individualised/personalised (genomic) medicine; (n) sociological aspects of PCM; (o) the medical humanities and PCM; (p) ethical and medico-legal implications of PCM; (q) the role of the family and of friends in caring and decision making; (r) the development and use of information technology and medical informatics for the development, application and evaluation/audit of PCM; (s) person-centred design and operation of healthcare facilities; (t) health service policies and policy-making for PCM; (u) the national and international health politics of PCM, (v) the role of medical education and PCM & (w) people-centred public health. We therefore welcome contributions for consideration across all of these

distinct areas of study detailed above and in the following formats: (i) Full scientific papers deriving from original research; (ii) Learned review articles presented as structured or systematic reviews; (iii) Commentaries and Editorials; (iv) Brief and Rapid Communications; (v) Essays, Opinions and Viewpoints; (vi) Critiques and Analyses; (vii) Book Reviews; (viii) Conference Reports; (ix) Letters to the Editor & (x) Research Letters. Conclusion

In conclusion, is our fervent hope that the IJPCM will provide an effective forum for the rapid communication of advances in PCM and a major vehicle for the stimulation of thinking, scholarly interchange and basic and applied research as they pertain to the personalization of care for the patient and the development of humanistic models of care for groups of individual patients within the context of their social settings. This function should help provide new insights into how an increasing personalisation of health services can contribute importantly to causal increases in the quality of care and to patient and professional satisfaction with health processes and outcomes in the clinic and at the bedside. A key function of the IJPCM will be to act as an impartial forum for the airing of controversies, with a particular role in stimulating the thinking necessary to resolve differences in the approach to clinical practice as the paradigm shift - from impersonal, fragmented and decontextualized treatment to personalised, integrated and contextualised care – continues to progress. We envisage that the IJPCM, functioning in this manner, will provide existing healthcare professionals with rapidly communicated, globally derived information on developments in person-centered medicine and people-centered public health and that it will furthermore act as a valuable resource for students at various points in their academic and clinical training.

Acknowledgements

A large number of highly distinguished individuals with impressive and well established international reputations in their fields have agreed to join the Editorial Board of the Journal, some of them accepting the onerous task of a regional editor. These colleagues represent the field of person-centered medicine in its broadest manifestations and we are deeply grateful to them for their participation and assistance in the work of the Journal. As eminent scholars, they will function not only as learned referees for IJPCM as part of the peer review process, but also as contributing authors and will play a vital role in promoting the Journal as part of their ongoing work within their own countries and particularly on the international stage.




References

[1] Heath, I. (2005). Promotion of disease and corrosion of medicine. Canadian Family Physician 51, 1320 – 1322. [2] Miles, A. (2009). On a Medicine for the Whole Person: away from scientistic reductionism and towards the embrace of the complex in clinical practice. Journal of Evaluation in Clinical Practice 15, 941-949. [3] Miles, A. (2011). On the need for person-centered clinical practice. International Journal of Person Centered Medicine 1 (2). In Press. [4] Miles, A. (2011). Individualising healthcare in an age of scientific advance and economic constraint: person-centered clinical practice and people-centered public health. Annali dell’ Istituto Superiore di Sanita’ 47. In Press. [5] Miles, A., & Loughlin, M. (2011). Science with humanity versus scientism and technocracy: the need for a

radical change in clinical philosophy. Journal of Evaluation in Clinical Practice 17 (4). In Press. [6] Gordon, J. (2005). Medical humanities: to cure sometimes, to relieve often, to comfort always. Medical Journal of Australia 182, 5-8. [7] Scheurich, N. (2003). Reconsidering spirituality and medicine. Academic Medicine 78, 356-360. [8] Mezzich, J. E., Snaedal, J., van Weel, C., & Heath, I. (2010). Conceptual explorations on Person-centered Medicine. International Journal of Integrated Care 10 (suppl.) [9] Mezzich, J. E., Snaedal, J., van Weel, C., & Heath, I. (2010). From disease to patient to person: towards a person-centered medicine. Mount Sinai Journal of Medicine 77, 304-306. [10] Mezzich, J. E. (2011). The Geneva Conferences and the emergence of the International Network for Person-centered Medicine. Journal of Evaluation in Clinical Practice 17, 333-336.


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THE INTERNATIONAL JOURNAL OF PERSON CENTERED MEDICINE

Table of Contents Volume 1 Issue 1 2011 Editorial Introduction 1 Advancing the global communication of scholarship and research for personalized healthcare: the International Journal of Person Centered Medicine Andrew Miles and Juan E. Mezzich Third Geneva Conference on Person-Centered Medicine Part One 6 The Third Geneva Conference on Person-Centered Medicine: Collaboration across specialties, disciplines and programs Juan E.

Mezzich and Andrew Miles Conceptual Perspectives 10 Building Person Centered Medicine through Dialogue and Partnerships Juan E. Mezzich 14 African Approaches to an enriched ethics of person-centred health practice Werdie (CW) Van Staden The Team Approach in Person-centered Health Care 18 Person Centered Medicine and the Primary Care Team – securing continuity of care Annemarie Uijen, Henk Schers and Chris van Weel 20 Nurses and Person- Centred Care Tesfamicael Ghebrehiwet 23 The Team Approach in Person-Centred Health Care: The Social Work Perspective Terry Bamford Person-centered Basic Communication Skills 27 What makes them (not) talk about proper medication use with their patients? Sandra van Dulmen, Evelien van Bijnen 35 Best Evidence Teaching of Person-centred Basic Communication Skills: a reflection E.M. van Weel-Baumgarten and M.H. Brouwers Person-centered Clinical Care Activities 39 Conceptual Appraisal of the Person-centered Integrative Diagnosis Model Ihsan M Salloum and Juan E. Mezzich 43 Person-centered Therapeutics C. Robert Cloninger and Kevin M. Cloninger 53 Person Centred Medicine for the Older Patient, with Specific Reference to the Person with Dementia Jon Snaedal Cultural Diversity and Person-centered Health Care 56 Culture, Ethics & Medicine in South Asia Roy Abraham Kallivayalil and Rakesh K Chadda 62 Person centered care and Economic Deprivation: an epidemiological view of positive mental health in a less-developed country Javier

E. Saavedra, Victor Cruz, Juan E. Mezzich 76 Person Centered Care and Gender Diversity Islene Araujo de Carvalho Special Initiatives for Person-centered Care 79 Person Centered Medicine Theory, Teaching And Research Giuseppe R. Brera 90 International Federation of Medical Students Association: views on Person-Centered medicine Remco Kruithof and Chijioke Kadura 92 The World Federation for Mental Health (WFMH) – International Network for Person-Centered Medicine (INPCM) Project: Mental Health

as a Priority: Adopting a Holistic Approach to Patient Care Helen L Millar and Mohammed T Abou-Saleh 98 Person Centered Medicine and the Perspective of the International Federation of Gynaecology and Obstetrics – the example of

screening for chromosomal anomalies in pregnancy Wolfgang Holzgreve and Gamal Serour 101 Bulgarian Person Centered Public Health Project Jeliazko Hristov, Drozdstoj S. Stoyanov, Bianka Tornjova and Donka Dimitrova 105 Person-centred Psychodynamic Perspectives Margit Schmolke 109 Developing an Institutional Informational Base and Bibliographical Clearinghouse Levent Kirisci, Maureen Reynolds, Michael Vanyukov,

Ty Ridenour, Jeanine Hayes and Juan E. Mezzich In Review 112 Tailoring care to individuals and populations within resource-poor settings: A review and commentary on the World Health

Organisation Report People-Centred Care in Low and Middle Income Countries A Miles Special Section: Conceptual Bases of Psychiatry for the Person 118 Forewords 120 Introduction to the Conceptual Bases of Psychiatry for the Person Juan E. Mezzich, George Christodoulou and K.W.M. Fulford 124 Historical Views on Psychiatry for the Person Jean Garrabe and Paul Hoff 127 Philosophy of Science Perspectives on Psychiatry for the Person Tim Thornton and Kenneth F. Schaffner 129 Values and Ethics Perspectives on Psychiatry for the Person KWM Fulford, George Christodoulou and Dan J. Stein 132 Psychological Perspectives on Psychiatry for the Person Michel Botbol, Yrjö O. Alanen, Dusica Lecic Tosevski and Margit Schmolke 135 Biological Perspectives on Psychiatry for the Person C. Robert Cloninger , Mohammed Abou Saleh, David A. Mrazek, Hans-Jürgen Möller 138 Social Perspectives on Psychiatry for the Person Wolfgang Rutz, Manuel Fernandez and Jitendra Trivedi 141 Ethnomedical and Cultural Foundations of Psychiatry for the Person Horacio Fabrega Jr and Ronald Wintrobb 144 Spirituality, Religion and Psychopathology: Towards an integrative psychiatry John Cox and Peter J. Verhagen 147 Literature and the Arts Perspectives on Psychiatry for the Person Ekaterina Sukhanova, Hans-Otto Thomashoff and Yves Thoret 149 Service User and Family Perspectives on Psychiatry for the Person Jan Wallcraft, Sigrid Steffen and Michaela Amering Regular Articles 152 Measuring Family Centred Care: Working with Children and Their Parents in a Tertiary Hospital Linda Shields, Abdulla A. Mamun,

Sandra Pereira, Pam O'Nions and Gervase Chaney 158 The role of patient management in medical expertise development: Extending the contemporary theory Alireza Monajemi and Remy

M.J.P. Rikers 164 Care requirements of patients with advanced cancer within a specialist centre – moving to person-centered approaches Donna Milne,

Lisa Sheeran, Tracey Dryden, Linda Mileshkin and Sanchia Aranda 174 Comparing breast and lung cancer patients’ experiences at a UK Cancer Centre: implications for improving care and moves towards a

person centered model of clinical practice Elizabeth A Davies, Peter Madden, Victoria H Coupland, Mairead Griffin, and Alison Richardson 187 Medicine And Spirituality: The role of love in the therapeutic process of HIV/AIDS sufferers in an African village Andrew Lightbown and

Nicholas Fane 193 Person-centred care: Bridging current models of the clinician-patient relationship Stephen Buetow

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