Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.
Int J Health Policy Manag. 2018 Apr 1;7(4):349-352. doi: 10.15171/ijhpm.2017.95.
In their 2017 article, Mannion and Exworthy provide a thoughtful and theory-based analysis of two parallel trends in modern healthcare systems and their competing and conflicting logics: standardization and customization. This commentary further discusses the challenge of treatment decision-making in times of evidence-based medicine (EBM), shared decision-making and personalized medicine. From the perspective of systems theory, we propose the concept of individualized standardization as a solution to the problem. According to this concept, standardization is conceptualized as a guiding framework leaving room for individualization in the patient physician interaction. The theoretical background is the concept of context management according to systems theory. Moreover, the comment suggests multidisciplinary teams as a possible solution for the integration of standardization and individualization, using the example of multidisciplinary tumor conferences and highlighting its limitations. The comment also supports the authors' statement of the patient as co-producer and introduces the idea that the competing logics of standardization and individualization are a matter of perspective on macro, meso and micro levels.
在他们 2017 年的文章中，曼尼恩和埃克斯沃西对现代医疗体系中的两个并行趋势及其相互竞争和冲突的逻辑进行了深入思考和理论分析：标准化和定制化。本评论进一步讨论了循证医学（EBM）、共同决策和个性化医学时代的治疗决策制定所面临的挑战。从系统论的角度，我们提出了个体化标准化的概念作为解决问题的方案。根据这一概念，标准化被概念化为指导框架，为医患互动中的个体化留出空间。理论背景是系统理论中的情境管理概念。此外，该评论还以多学科肿瘤会议为例，提出了多学科团队作为整合标准化和个体化的一种可能解决方案，并强调了其局限性。该评论还支持作者关于患者作为共同生产者的观点，并引入了标准化和个体化的竞争逻辑是宏观、中观和微观层面观点的观点。
