Values and context in person-centered diagnosis

Abstract

A sound and effective approach to psychiatry and medicine should prioritize the whole person. This implies an ethical commitment to the person behind the patient, and attention to the biological, psychological, social, cultural, and spiritual bases of illness and positive health. As part of this comprehensive approach, attention to values and context are required for an adequate diagnostic informational base and optimal planning of care. A model for person-centered and contextualized diagnosis of mental health has been developed under the name of Person-centered Integrative Diagnosis (PID) within the framework of person-centered psychiatry and medicine. It engages recent and evolving methodological approaches, which are addressed to enhancei the reliability and validity of diagnostic systems. Among the cardinal features of the PID model, are the diagnosis of a person’s whole health (both ill and positive health), considering diagnosis as both a formulation and an interactive process among clinicians, patients and families, and the use of categories, dimensions, and narratives as descriptive tools. Its multilevel informational structure encompasses health status, health contributors, and health experience and values. On the above bases, the PID contrasts with conventional diagnostic systems such as the DSM and ICD illness-classification models. Representing an application of the PID model, the GLADP-VR, a Latin American Guide of Psychiatric Diagnosis (using ICD-10 categories and codes of illness) has been recently published by the Latin American Psychiatric Association for the use of health professionals in the region. This paper identifies the thrusts and elements of the PID model, which represent attention to values and context. This includes ethical commitment through concern for the person's dignity, complexity, uniqueness and autonomy, and incorporation of the cross-sectional and historical context as well as the values, expectations, and preferences of the person presenting for care.