Walach Harald, Loughlin Michael
Department of Pediatric Gastroenterology, Medical University Poznan, Poznań, Poland.
Department of Psychology, University Witten-Herdecke, Witten, Germany.
Philos Ethics Humanit Med. 2018 Oct 14;13(1):13. doi: 10.1186/s13010-018-0068-x.
The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness.
Philosophical analysis of background assumptions of the current paradigmatic model.
While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of "the patient". This narrative is conceptually linked to the developing philosophy of person-centred care.
If patients are seen also as "agents" this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients' motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from "treating" and "battling" diseases and their purported "mechanisms" to understanding complex contributing factors and their interplay.
医学在治疗患者方面的成功带来了新的挑战。越来越多的人继续遭受功能性、慢性或多因素疾病的折磨，这引发了对健康和疾病因果决定因素进行更复杂分析的呼声。
对当前范式模型的背景假设进行哲学分析。
虽然这些因素并不需要彻底的范式转变，但它们确实促使我们去构建一种新的叙事方式，以补充现有的、塑造我们医疗护理思维的叙事方式。在本文中，我们认为对生活方式和共同决策的更多关注需要一种关于能动性的新叙事，以补充“患者”叙事。这种叙事在概念上与以患者为中心的护理发展理念相关联。
如果将患者也视为“能动者”，这将导致实际决策发生重大转变：这种叙事方式的发展和采用将有助于从业者与患者合作实现互利，激发患者的积极性，将重点从治疗转向预防，并避免因过度关注患者叙事而产生的不必要和有害的治疗。它还将有助于将研究工作，包括概念性和实证性的，从“治疗”和“对抗”疾病及其所谓的“机制”转向理解复杂的促成因素及其相互作用。
