Contributed to the World Medical Journal 2009
August 19, 2009
The International Network for Person-centered Medicine:
Background and First Steps
Juan Mezzich (WPA President 2005-2008), Jon Snaedal (WMA President 2007-2008), Chris van Weel (Wonca President 2007-2010), Iona Heath (Wonca Executive Committee)
The earliest roots of person-centered medicine can be found in ancient civilizations, both Eastern (such as Chinese and Ayurvedic) and Western (particularly ancient Greek), which tended to conceptualize health broadly and holistically. This notion is reflected in the encompassing definition of health inscribed in the constitution of the World Health Organization (WHO, 1946). Also noticeable in medical traditions from those early civilizations is a personalized approach to health care.
The modern development of medicine has, however, neglected the above considerations and privileged conceptual reductionism, paid absorbed attention to disease, super specialization and fragmentation of services as well as commoditization and commercialism in the field. This has interfered with attentiveness to the whole person and his/her ill- and positive-health as the natural focus of medical science and practice and to the ethical imperatives connected to promoting the autonomy, responsibility, and dignity of every person involved.
Endeavors to refocus medicine on the person of the patient, the clinician and the members of the community at large have been distinctly noted in the past century. Illustratively, Paul Tournier, a Swiss general practitioner discovered the transformational value of critical interpersonal experiences and of attending to the whole person and the biological, psychological, social and spiritual aspects of health. He presented his vision on Medicine de la Personne (Tournier, 1940) and 19 other books translated to over 20 languages. Around the same time, American psychologist Carl Rogers demonstrated the significance of open communication and of empowering for individuals to achieve their full potential (Rogers, 1961) and proceeded to develop a personcentered approach to therapy, counseling and education.
During the second half of the 20th Century, Frans Huygen in the Netherlands, Ian Mc Whinney in the UK and Canada, and Jack Medalie in the United States and Israel struggled with the ongoing limitations of modern medicine noted above and committed themselves to promote a broad and contextualized understanding of health with high concern for their patients’ well-being. They went on to develop a generalist medical specialty under the terms of general practice and family medicine (Huygens, 1978; McWhinney, 1989), which has characteristically focused on patient-centered care. Sustained efforts to establish a person-centered medicine program on epistemological grounds and to build a corresponding medical school and clinical teaching method have been undertaken by Giuseppe Brera (1992), rector of Ambrosiana University in Milan. Another inspirational medical figure has been Finn psychiatrist Yrjo Alanen, who engaged patients by paying careful attention to the meaning of their experiences and the nature and significance of their needs, and artfully combined pharmacological and psychosocial therapeutic techniques. His need-adaptive assessment and treatment approach (Alanen, 1997) has impressed not only professional colleagues but even critical patient groups.
Noteworthy too are the emerging responses from a number of global medical and health organizations. The World Health Organization, which incorporated in its constitution the above mentioned comprehensive definition of health, has recently introduced the term dynamic, meaning interactive, to characterize the relationship among dimensions of well-being and has started discussions on the possibility of adding a spirituality dimension. Furthermore, for the first time WHO is placing people/person at the center of healthcare and public health, as reflected on the resolutions of the World Health Organization’s 2009 World Health Assembly.
Linked to person-centered care perspectives is an ethical frame of reference that seeks to assure equal opportunities for all, particularly in terms of access to care, with an emphasis on the rights of individuals in need of health care (www.wma.net/policy). The triad of caring, ethics, and science are reaffirmed as the enduring traditions of the medical profession (Coble, 2005). The physicians' obligation to respect human life rather than to extend it blindly has been cogently argued (Snaedal, 2007). This has been incorporated by the World Medical Association (WMA) into the Declaration of Helsinki for Medical Research and the International Code of Medical Ethics (www.wma.net/press releases).
The renaissance of family medicine after the Second World War was informed by holistic perspectives which grounded the role of the general practitioner/family physician in an integrated approach to the care of patients and their families in the context of a specific local community (Mc Whinney, 1989). The World Organization of Family Doctors (Wonca) has recorded its commitment to persons and community in its basic concepts and values – continuity of care, care for all health problems in all patients within a societal context (www.woncaeurope.org).
The tension between the disease and the person experiencing the disease is particularly tangible in mental health care. In fact, as documented by Garrabe (2008), the beginnings of the World Psychiatric Association (WPA) in 1950 already revealed interest on the concept of the person as central to the field. That interest evolved to the point that in 2005 the WPA General Assembly established an Institutional Program on Psychiatry for the Person. This program sought to articulate science and humanism to promote a psychiatry of the person, for the person, by the person, and with the person (Mezzich, 2007). Among its signal conferences were those organized in London (October 2007) in collaboration with the UK Department of Health and in Paris (February, 2008) in cooperation with the WPA French Member Societies. In addition to a number of journal papers, monographs have been prepared on the Conceptual Bases of Psychiatry for the Person (Mezzich, Christodoulou & Fulford, in press) and on Psychiatric Diagnosis: Challenges and Prospects (Salloum & Mezzich, 2009).
Geneva Conferences on Person-centered Medicine
The Geneva Conferences on Person-centered Medicine took place at the Geneva University Hospitals on May 29-30, 2008 and May 28-29, 2009 as landmarks in a process of building an initiative on medicine for the person through the collaboration of major global medical and health organizations and a growing group of committed individuals. The institutions formally involved in either or both Conferences included the World Medical Association (WMA), the World Organization of Family Doctors (Wonca), the WPA Institutional Program on Psychiatry for the Person (IPPP), the International Network for Person-centered Medicine, the Council for International Organizations of Medical Sciences (CIOMS), the World Federation for Mental Health (WFMH), the World Federation of Neurology (WFN), the World Association for Sexual Health (WAS), the International Association of Medical Colleges (IAOMC), the World Federation for Medical Education (WFME), the International Federation of Social Workers (IFSW), the International Council of Nurses (ICN), the European Federation of Associations of Families of People with Mental Illness (EUFAMI), the International Alliance of Patients’ Organizations (IAPO), the University of Geneva School of Medicine, and the Paul Tournier Association.
The First Geneva Conference on Person-centered Medicine was aimed at presenting and discussing the experience on person-centered principles and procedures gained through a Person-centered Psychiatry Program, exploring the conceptual bases of person-centered medicine, and engaging interactively major international medical and health organizations. It included sessions on international organization perspectives on person-centered medicine, related special initiatives, conceptual bases of person-centered medicine, personal identity, experience and meaning in health, a review of Paul Tournier’s vision and contributions, person-centered health domains, clinical care organization, person-centered care in critical areas, and person-centered public health. The upgraded papers presented at the Conference are being published as a supplement of the International Journal of Integrated Care (Mezzich, Snaedal, van Weel & Heath, in press) The Second Geneva Conference was aimed at probing further key concepts of person-centered medicine and reviewing a number of practical approaches for the implementation of this approach through a collaborative effort with an enlarged number of international health organizations. Through nine sessions, it covered institutional perspectives and activities on person-centered medicine, other relevant initiatives, concepts and meanings of person-centered medicine, procedures for diagnosis, treatment and health promotion in medicine for the person, person-centered medicine for children and older people, as well as training, research, health systems and policies on person-centered medicine. Among the conference conclusions were a wide commitment to the importance of person-centered medicine for the health of persons and populations, clarification of the availability of conceptual, educational and research tools, and the need to fit these into health encounters and systems, affirming person-centeredness as an intrinsic quality rather than an additional commodity. There was consensus on organizing a Third Geneva Conference where emphasis would be placed on building further bridges to the specialized sphere of medicine, other health professions, and various patient groups. Among additional next steps are the organization of relevant scientific events such as a New York Conference on Well-Being and the Person, publication of a joint editorial in an international journal, preparing a monograph with the papers presented at the Second Geneva Conference, responding positively to requests from WHO for collaboration on people-centered care strategies adopted by the 2009 World Health Assembly, and further development of the International Network for Person-centered Medicine to help move forward collaboratively an optimized vision for health care.
Professors Juan E. Mezzich (USA), Jon Snaedal (Iceland), Chris van Weel (The Netherlands), and Iona Heath (United Kingdom), Members of the Board of the International Network for Person-centered Medicine (INPCM).
Constructing the International Network for Person-centered Medicine
The International Network for Person-centered Medicine (INPCM) is a non-for-profit educational, research, and advocacy organization emerging from the above outlined Geneva Conferences process and aimed at developing opportunities for a fundamental re-examination of medicine and health care to refocus the field on genuinely person-centered care. Person-centered medicine is dedicated to the promotion of health as a state of physical, mental, social and spiritual wellbeing as well as to the reduction of disease, and founded on mutual respect for the dignity and responsibility of each individual person. To this effect, the INPCM seeks to articulate science and humanism in a balanced manner, engaging them at the service of the person. The purposes of the INPCM may be further summarized as promoting a medicine of the person (of the totality of the person's health, including its ill and positive aspects), for the person (promoting the fulfillment of the person’s life project), by the person (with clinicians extending themselves as full human beings with high ethical aspirations), and with the person (working respectfully, in collaboration, and in an empowering manner).
The expected INPCM activities include the following: a) Organization of conferences and other scientific meetings promoting person-centered care in medicine at large and in its various specialties and related health fields, b) Preparation of person-centered clinical practice guidelines relevant to diagnosis, treatment, prevention, rehabilitation and health promotion, c) Preparation of educational programs, including curricula, aimed at the training of health professionals on person-centered care, d) Conduction of studies and research projects to explore and validate person-centered care concepts and procedures, e) Preparation of publications to disseminate and advance the principles and practice of person-centered medicine, f) Development of advocacy forums and activities to extend and strengthen person-centered medicine with the participation of clinicians, patients and families, as well as members of the community at large, g) Establishment of an internet platform to support archival, informational, communicational, and programmatic efforts on person-centered medicine.
All organizations and individuals who have participated actively in relevant programmatic activities, such as the Geneva Conferences, will be invited to participate in the INPCM. It will be organizationally developed and guided initially by a board of five to eight persons with a clear track record of work on person-centered medicine and who are committed to the promotion of the fundamental purposes of the organization. Additional structures to be considered are an advisory council (composed of eminent experts and representatives of major collaborating organizations) and an operational council (composed of leaders of emerging INPCM Programs, i.e., conceptual and ethical bases, diagnosis, clinical care, training, research, health systems, and public policies).
Support for the INPCM and its activities is expected to come, as it has been for its initial steps, from academic institutions, professional societies, governmental organizations, foundations, person-centered medicine and psychiatry non-profit program funds, and conference registration fees. Any support from industry sources will be accepted provided it is transparent and unrestricted.
Further information on the INPCM can be obtained at www.personcenteredmedicine.org.
Colophon
Early scientific and ethical efforts coalesced through the First and Second Geneva Conferences, and are finding fruition in the International Network for Person-centered Medicine. Encouragement is afforded by the wide array of collaborating organizations, the scholarly dedication of committed individuals, and the conviction that the greatest asset of any community is its capacity to organize itself.
References
Alanen Y: Schizophrenia: Its Origins and Need-Adaptive Treatment. London: Karnak, 1997.
Brera GR: Epistemological aspects of medical science . Medicine and Mind, 7: 5-12, 1992.
Coble Y (Ed): Caring Physicians of the World. Ferney-Voltaire, France: World Medical Association, 2005.
Garrabe J: Historical views on Psychiatry for the Person. Paper presented at the Paris Conference on Personcentered Psychiatry, World Psychiatric Association French Member Societies Association, February 6-8, 2008
Huygen, FJA. Family medicine – the medical life history of Dutch families. Brunner Mazel, New York, 1982.
Original publication: Dekker en van der Vegt, Nijmegen, 1978 McWhinney IR: Family Medicine: A Textbook. Oxford: Oxford University
Press, 1989.
Mezzich JE: Psychiatry for the Person: Articulating science and humanism. World Psychiatry 6: 1-3, 2007.
Mezzich JE, Christodoulou G, Fulford KWM (eds): Conceptual Bases of Psychiatry for the Person. Psychopathology, in press.
Mezzich JE, Snaedal J, van Weel C, Heath I (Eds): Conceptual Explorations on Person-centered Medicine. International Journal of Integrated Care, in press.
Rogers C: On Becoming a Person. Boston: Houghton Mifflin, 1961.
Salloum IM, Mezzich JE (Eds): Psychiatric Diagnosis: Challenges and Prospects. Chichester, UK: Wiley- Blackwell, 2009.
Snaedal J: Presidential Address. World Medical Journal, 53: 101-102, 2007.
Tournier P: Medicine de la Personne. Neuchatel, Switzerland: Delachaux et Niestle, 1940.
World Health Organization: WHO Constitution. Geneva: WHO, 1946.
World Health Organization: World Health Assembly Resolutions. Geneva: Author, 2009.