I was pleased to read an article which promotes a patient-centred
approach to healthcare, particularly one which provides the evidence base
to promote patient involvement in their own health services.
Scientific and technological advances give us an ever-more complex
evidence base for health-care decisions and thus reveal an ever-widening
range of choices in health care (Woodbridge, 2004). As soon as there are
choices, then it is patients’ values which will determine the choices they
In the 1980s, when the patient-centred clinical method was first
being developed and used in research and education, it was at the
periphery of medicine, and was regarded by many as being a "soft science"
(Stewart et al, 2003). This view has remained for many, particularly when
the patient-centred method is compared to the "hard science" of evidence-
There is no reason why a subjective, values-based approach cannot sit
alongside the objective, factual approach, and concerns about conflict
between values-based practice and Evidence Based Medicine are unfounded.
To be patient-centred we must have a strong understanding of the factual
evidence, but also understand the patient’s unique set of values and
experiences. This is an aspect which is highlighted in EBM, which promotes
the integration of three key elements: best research evidence, clinical
expertise and patient values (Sackett et al, 2000). In order to do this
effectively there should be application of the patient-centred ethos in
taking into account the illness experience, the person and the context in
which the illness presents in order to find common ground between both the
physicians and the patient's perspective.
It is easy as doctors (who have received many years of scientific
training) to take the biological, objective stance in regard to our
patients’ care, and investigate the disease process presented to us. I
suggest that it is much harder to take the approach of looking at the
subjective experience of illness in the person in front of us. This is
what is required in addition to the biological position for a balanced,
truly patient-centred approach.
Sackett DL, Strauss SE, Scott Richardson W, Rosenberg W & Haynes
RB, 2000. Evidence-Based Medicine: How to Practice and Teach EBM (2nd
Edition). Churchill Livingstone, Edinburgh.
Stewart M, Brown JB, Weston WW, McWhinney I, McWilliam CL &
Freeman TR, 2003. Patient-Centred Medicine. Transforming the clinical
method. Radcliffe Medical Press, Oxford.
Woodbridge K, Fulford KWM, 2004. Whose values? A workbook for values
-based practice in mental health care. The Sainsbury Centre for Mental
Competing interests: No competing interests