Person-centered Medicine Research Articles

Association between emotional intelligence and empathy among medical students: a single center cross-sectional study, Brazil, 2019

Abstract: Introduction: Emotional intelligence (EI) and empathy are two essential skills for person-centered Medicine. Objectives: To evaluate the association between EI and empathy and to assess whether sociodemographic factors and year at the medical school influence the level of EI and empathy. Methods: Cross-sectional study carried out in medical students from a private educational institution in the city of São João del-Rei, Minas Gerais, Brazil. EI levels were assessed using the Schutte Self-report Emotional Intelligence Test and empathy levels were assessed using the Jefferson Scale of Empathy (student version). All volunteers signed the Informed Consent Form before inclusion in the study. The statistical analysis used mean values, standard deviation, frequency distribution, Student’s t test, Pearson’s correlation, and linear regression. A significance level of 0.05 was considered. Results: From August 5 to 30, 2019, 193 volunteers, corresponding to 85.8% of the total population, agreed to participate in the study. The total EI (129.8 ± 13.3) and empathy (121.2 ± 11.6) observed scores were high. EI scores were influenced only by age (padjusted = 0.018). Students attending more advanced semesters had higher total empathy scores (padjusted = 0.013). Students whose parents did not have a higher education degree also had a higher total empathy score (padjusted = 0.031). A moderate positive correlation was observed between the total EI and empathy scores ( ρ =0.304, p<0.001) and between the total empathy score and the EI domain Managing Others’ Emotions ( ρ =0.300, p<0.001). A weak positive correlation was also observed between the total EI score and most of the empathy domains. Conclusion: A positive correlation between emotional intelligence and empathy was observed. The age influenced EI and the year of medical school and parental schooling influenced empathy.

Depression as a biopsychosocial problem

The article discusses the role of biological and psychological adaptive and compensatory mechanisms in the aetiology and pathogenesis of affective disorders, the relationship between the genetic characteristics of an individual, which determine vulnerability, and epigenetic mechanisms dependent on external psychosocial influences. The role of psychological factors disrupted the consistency of mental functions and the preservation of individuality that determines the psychogenesis of the disease both at the borderline and at the psychotic level is indicated. The psychoprophylactic and therapeutic role of psychotherapy is substantiated with an analysis of its influence both on the biological parameters of the brain and on the psychological characteristics of an individual, including an assessment of the quality of life. A comprehensive biopsychosocial approach to a spectrum of affective disorders makes a significant contribution to the development of personalized person-centered medicine, considering the phenomenological characteristics of the disease, as well as the psychological characteristics of patients and the nature of their social adaptation, which increases the effectiveness of treatment and rehabilitation of mentally ill patients.

Association between emotional intelligence and empathy among medical students: a single center cross-sectional study, Brazil, 2019

Abstract: Introduction: Emotional intelligence (EI) and empathy are two essential skills for person-centered Medicine. Objectives: To evaluate the association between EI and empathy and to assess whether sociodemographic factors and year at the medical school influence the level of EI and empathy. Methods: Cross-sectional study carried out in medical students from a private educational institution in the city of São João del-Rei, Minas Gerais, Brazil. EI levels were assessed using the Schutte Self-report Emotional Intelligence Test and empathy levels were assessed using the Jefferson Scale of Empathy (student version). All volunteers signed the Informed Consent Form before inclusion in the study. The statistical analysis used mean values, standard deviation, frequency distribution, Student’s t test, Pearson’s correlation, and linear regression. A significance level of 0.05 was considered. Results: From August 5 to 30, 2019, 193 volunteers, corresponding to 85.8% of the total population, agreed to participate in the study. The total EI (129.8 ± 13.3) and empathy (121.2 ± 11.6) observed scores were high. EI scores were influenced only by age (padjusted = 0.018). Students attending more advanced semesters had higher total empathy scores (padjusted = 0.013). Students whose parents did not have a higher education degree also had a higher total empathy score (padjusted = 0.031). A moderate positive correlation was observed between the total EI and empathy scores ( ρ =0.304, p<0.001) and between the total empathy score and the EI domain Managing Others’ Emotions ( ρ =0.300, p<0.001). A weak positive correlation was also observed between the total EI score and most of the empathy domains. Conclusion: A positive correlation between emotional intelligence and empathy was observed. The age influenced EI and the year of medical school and parental schooling influenced empathy.

A Model of an Integrative Approach to Breast Cancer Patients.

Background:Breast cancer (BC) survivors have physical and psychological needs that require convincing responses by health care providers. The quality of life issue and clinical unmet needs are among the main reasons pushing a number of patients toward “natural” therapies that are often misleading and alternative to mainstream cancer care. Integrative Oncology (IO) tries to respond to many of those needs, by combining lifestyle counseling, body-mind activities, and complementary evidence-informed therapies with anticancer standard treatments.Methods:In our model at Fondazione Policlinico Gemelli (FPG), every woman diagnosed with a BC waiting for surgery or candidate to neoadjuvant chemotherapy undergoes a preliminary psycho-oncological distress evaluation and a brief lifestyle interview. Anthropometric measurements, body composition analysis, and individual levels of physical activity are recorded. Patients are given evidence based recommendations about the advisable diet and physical activity in a prehabilitation setting. A physician provides patients with information about integrative care plans to treat symptoms related to the disease or its treatments. Therapeutic approaches include acupuncture, mindfulness-based protocols, qigong, massage therapy, and classes of music/art therapy.Results:Between September 2018 and February 2020, the Center for Integrative Oncology at FPG has carried out 1249 lifestyle counseling sessions, 1780 acupuncture treatments, 1340 physiotherapy sessions, 3261 psycho-oncological consultations, 218 herbal medicine counseling sessions. Moreover, 90 BC patients completed the mindfulness based stress reduction (MBSR) protocol and 970 patients participated in qigong, art therapy, and music therapy classes.Conclusions:Our integrative approach aims to achieve a person-centered medicine by improving symptoms management, adherence to oncological protocols, and eventually overall quality of life.

Influência do bem-estar psicossocial do idoso no enfrentamento de adversidades em saúde: relato de experiência

Objetiva-se relatar a experiência de atividades de abordagem familiar realizadas com uma paciente idosa, de amplo histórico de enfrentamento de adversidades em saúde e sociais, assistida na Estratégia Saúde da Famí­lia. Trata-se de um estudo descritivo, tipo relato de experiência, vivenciado a partir de visitas domiciliares por estudantes do primeiro ano do curso de medicina, sob orientação de duas professoras, em um núcleo familiar residente no Bairro Castelão (Fortaleza/CE). Por meio da aplicação de ferramentas de abordagem familiar, percebeu-se que os fatores psicossociais tendem a influenciar na qualidade de vida, na forma de percepção da doença e na realização das ações de saúde do idoso, o que contribui para o bem-estar na senilidade. A experiência enriqueceu a formação dos discentes ao estimular a ampliação dos conhecimentos voltados para preceitos da Medicina Centrada na Pessoa, incitando o reconhecimento diferenciado do indiví­duo, do seu contexto familiar e da sua inserção social.

A non-modern vision: facts and values in psychotherapy

Evidence-based practice in psychology is the prevailing regulatory principle for psychotherapy practice. This paper criticises the notion of facts and values in evidence-based practice in psychology and related concepts. More particularly, it aims at showing that values-based practice follows a modern scheme contrasting facts and values sharply. Person-centred medicine is suggested as a more viable option. Person-centred medicine follows a non-modern scheme in which facts and values are integrated. This move, it is argued, will lead to a more humanistic conception of the patient and psychotherapy.

Acknowledging Patient Expertise and the Negotiation of Meanings in the Clinical Encounter

Patient non-adherence is a common and important problem in clinical medicine. Some cases of patient non-adherence are cases in which the patient disagrees with the physician’s recommended treatment based on particular reasons. In this chapter, by drawing upon the science and technology studies literature, specifically the discussion by Collins and Evans and also Wynne of how best to understand scientific controversies, I relate their ideas to the analogous conflict that may occur within a clinical encounter. I draw upon their recognition of the importance of contributory expertise and interactional expertise in providing legitimate knowledge. I also draw upon Wynne’s idea of the ‘negotiation of meanings’ as an important element of the clinical interaction. To resolve potential conflicts between patient and physician before they develop into ‘non-adherence’, I propose the need for a new epistemological framework that recognizes legitimate knowledge offered by the patient as well as the physician. By situating this patient expertise framework within the paradigm of person-centred medicine, and by assuming the goal of medical treatment to be treatment of suffering, patient expertise becomes centralized as a means of determining the nature of patient suffering. Two aspects of the patient’s tacit knowledge - the body aspect and the meaning aspect - both of which are context-dependent and directly accessible only to the patient, are thus recognized as knowledge essential to the success of the interaction. The physician’s role becomes that of both medical expert and possessor of interactional expertise, by which the physician recognizes and includes patient expertise in the treatment decision. Finally, the patient expertise framework must also involve recognizing and incorporating the ‘negotiation of meanings’ into the development of a treatment plan. By acknowledging the importance of patient expertise and the negotiation of meanings, this patient expertise framework should dissolve the problem of patient non-adherence that derives from the patient disagreeing with the therapeutic plan.

Persons over models: shared decision-making for person-centered medicine

In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.

Self-Awareness of Performing Patient-Centered Medicine in General Practice / Family Medicine: Development of a Measurement Scale

Patient Centred Medicine is a method and a model of practicing allowing gains for both the doctor and the patient. Its practice must be evaluated for purposes of continuous professional development and continuous medical education. The aim of this study was to create an instrument focused in measuring the practice based on person centered medicine in general and family medicine, as well as in determining its reliability and validity. A first version of a questionnaire according to the four dimensions of the patient- centred clinical method was revised in a focus group providing the content validity. The final questionnaire includes 22 items, using a Likert scale with four response options. Factorial analysis made it possible to confirm the dimensions defined by Moira Stewart, and internal consistency, test-retest reproducibility and item-total correlations were determined. The online implementation of the questionnaire to a sample of 905 family doctors guaranteed the construct and criterion validities. The measurement instrument includes four dimensions: (i) exploring health, disease and the illness experience; (ii) investing in the doctor-patient relationship; (iii) seeking understanding; and (iv) understanding the whole person. The internal consistency was demonstrated with a global Cronbach's alpha of 0.892, varying between 0.783 and 0.844 for all dimensions. The test-retest reproducibility obtained an intraclass correlation value between 0.678 and 1.000. The item-total correlations varied between 0.457 and 0.870. Women doctors are more aware than their colleagues about seeking understanding with the person, and young doctors are more susceptible to approach the disease through history and to seek understanding with the patient. Specialist physicians have shown to be more careful with the history and with viewing the patient as a whole and the professionals who work in a Family Health Unit are those who seek a better understanding with the person. Finally, specific training about person centered medicine and about consultation in person centered medicine demonstrated a positive impact in all dimensions of the person-centred medicine and this is acknowledged by professionals. The assessment of self-perception of person-centred medicine is now possible. The questionnaire presents good reliability and validity, thus allowing doctors to assess their main weaknesses, as well as enabling the development of specific training.

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment.

Background. Dialysis treatment is improving, but several long-term problems remain unsolved, including metabolic bone disease linked to chronic kidney disease (CKD-MBD). The availability of new, efficacious but expensive drugs (intravenous calcimimetic agents) poses ethical problems, especially in the setting of budget limitations. Methods. Reasons of choice, side effects, biochemical trends were discussed in a cohort of 15 patients (13% of the dialysis population) who stared treatment with intravenous calcimimetics in a single center. All patients had previously been treated with oral calcimimetic agents; dialysis efficacy was at target in 14/15; hemodiafiltration was employed in 10/15. Median Charlson Comorbidity Index was 8. The indications were discussed according to the principlist ethics (beneficience, non maleficience, justice and autonomy). Biochemical results were analyzed to support the clinical-ethical choices. Results. In the context of a strict clinical and biochemical surveillance, the lack of side effects ensured “non-maleficence”; efficacy was at least similar to oral calcimimetic agents, but tolerance was better. Autonomy was respected through a shared decision-making model; all patients appreciated the reduction of the drug burden, and most acknowledged better control of their biochemical data. The ethical conflict resides in the balance between the clinical “beneficience, non-maleficience” advantage and “justice” (economic impact of treatment, potentially in attrition with other resources, since the drug is expensive and included in the dialysis bundle). The dilemma is more relevant when a patient’s life expectancy is short (economic impact without clear clinical advantages), or when non-compliance is an issue (unclear advantage if the whole treatment is not correctly taken). Conclusions. In a context of person-centered medicine, autonomy, beneficence and non-maleficence should weight more than economic justice. While ethical discussions are not aimed at finding “the right answer” but asking “the right questions”, this example can raise awareness of the importance of including an ethical analysis in the choice of “economically relevant” drugs.

Articulating Social Psychiatry and Person-Centered Medicine: Conceptual Bases and International Implications for COVID-19

Background: The World Association of Social Psychiatry (SP) and the International College of Person-Centered Medicine (PCM), while having their own background and goals, share some significant interests and concerns, raising hope for collaboration and synergism. Consideration of the COVID-19 pandemic that is severely challenging the world may also offer opportunities for organizations and programmatic perspectives to reflect on and optimize their paths. Objectives: This article is aimed at delineating a pattern of points of conceptual and strategic articulation between SP and PCM as perceived by scholars familiar with these perspectives, and to examine their implications for general health care and for responding to the evolving COVID-19 pandemic. Methods: This is primarily a consultation study involving clinical scholars familiar with the two perspectives at hand around a list of prospective articulation points between SP and PCM based on a selective literature review. The specific methods engaged involved elucidation of prominent SP/PCM articulation patterns through tabular displays of panelist ratings and contrast between such articulation points and recommendations from the UN and WHO for advancing general health care and responding to the COVID-19 pandemic. Results: The initial explorative elucidation of potential articulation points between SP and PCM, including a) Contextualized approach, b) Ethical commitment, c) Humanization of medicine, d) Concern for broad determinants of health, e) Commitment to health care and public health, and f) Contributing to UN SDGs, was supported by the ratings of panelists familiar with both perspectives and the recommendations of authoritative international health declarations (including those focused on COVID-19 response). This was particularly the case for complementary concern for health care and public health, a contextualized person/whole society approach, and ethical commitment to persons' values. Conclusions: The thrust of the results of the present study and their contrast with the emerging professional and scientific literature stimulated by the COVID-19 pandemic affords clarification and validity on the concepts and strategies of SP and PCM and opens new avenues for useful collaboration.

REPORT OF THE FIRST PERUVIAN CONFERENCE ON PERSON-CENTERED MEDICINE

In the first Peruvian Conference on Person-Centered Medicine, there are two concepts that were originally never separated: Comprehensive Health Care by All for All that Dr. David Tejada de Rivero articulated until his death at the end of 2018 and Person-Centered Medicine and Health that the International College of Person Centered Medicine and others have been promoting worldwide. From this perspective, it is completely natural to talk about Integral Person-Centered Health Care, because who, but the human person, is to whom integral health care can be directed. They join in this way, Alma Ata of 1978 with Lima of 2018, paying just tribute to the vision of the future from Halfdan Mahler and David Tejada de Rivero and posing a motivating stimulation to health professionals.

SUMMARY REPORT FROM THE 6TH INTERNATIONAL CONGRESS OF PERSON CENTERED MEDICINE

The idea that the Indian Medical Association (IMA) could host a congress on person-centered medicine (PCM) was presented at the 10th Geneva Conference on PCM in April 2017. The idea was well received and accepted by Prof. Ketan Desai, then President of the World Medical Association (WMA) and former President of the IMA. Soon thereafter preparations began as a collaborative effort of IMA and the International College of Person Centered Medicine (ICPCM). A contract was signed by representatives of IMA and ICPCM stipulating the framework and the financial issues of the congress.

MEDICAL PROFESSIONALISM AND ETHICAL AND HUMAN RIGHTS FOUNDATIONS OF PERSON-CENTERED MEDICINE

Person-centered medicine (PCM) is a concept that has gained increased acceptance, being a broader term than patient-centered medicine. With PCM the whole of a person is taken into consideration, whether healthy or in disease as well as his or her family. The person of the health professional is also incorporated in this concept. In this article, ethical background to person-centeredness in universal declarations and some international central policies are addressed. Primarily, the UN Universal Declaration on Human Rights (UDHR) will be discussed as well as official policy documents of the World Medical Association (WMA). Lastly, the content of a WMA Declaration on Medical Professionalism are discussed.

REPORT FROM THE SECOND COLLOQUIUM ON HEREDIAN SPIRIT AND PERSON CENTERED MEDICINE: HUMANISM AND SOCIAL RESPONSIBILITY

In celebration of the 57th anniversary of the Cayetano Heredia Peruvian University (CHPU), the Second Colloquium on “Heredian Spirit and Person-Centered Medicine: Humanism and Social Responsibility” was held on September 19, 2018. The colloquium was organized by the Cayetano Heredia student organizations and the Cayetano Heredia Alumni Foundation. The first Colloquium entitled “Heredian Spirit and Person Centered Medicine: From its Roots to the Future,” was held on September 15, 2017 at the Casa Honorio Delgado, and was organized by medical students of the University in collaboration with former students and current professors.

COMMUNICATION AND EMPATHY WITHIN PERSON-CENTERED MEDICINE: A DEVELOPMENTAL POINT OF VIEW

Communication between patients and health care providers (HCP) is at the heart of medicine and even more within its person-centered paradigm. Within a person centered medicine (PCM) perspective, it is thus crucial, for both the HCP and the patient, to build on a relationship with the objective to establish a therapeutic alliance and share decision making related to the patient’s health issues and to integrate the subjective aspects (and not only the objective aspects) of these health Issues. After showing that the effects of communication go beyond mere cognitive and affective sharing, particularly in highly emotional relations, this paper’sobjective is to understand more thoroughly what is transmitted in the patients/HCP relation and how some of the child and adolescent developmental psychiatry processes (i.e., early mother–baby interactions and transgenerational transmission of attachment) provide good models to understand this transmission.Building on these models, the paper will discuss how and at which conditions, the HCP’s narrative empathy plays a major role to access to the patient’s subjectivity through the HCP’s subjective experience. It concludes that, therefore, subjectivity of the HCPs should not be seen as a negative side effect of the patient–HCP (or the patient–team) relation but as a crucial clinical tool in person-centered diagnostics and cares if HCPs are properly trained and educated to use their feelings and representations as tools in individual or collective deliberations. But one has to be aware that there is no empathy without subjectivity.

EDITORIAL INTRODUCTION: ICPCM EDUCATIONAL PROGRAM ON PERSON-CENTERED CARE: CARE PLANNING, SHARED DECISION MAKING, AND INTERPROFESSIONAL COLLABORATION

This journal issue includes the third part of the Educational Program on Person-Centered Care of the International College of Person Centered Medicine (ICPCM) that in its initial version was presented at the 6th International Congress of Person Centered Medicine in New Delhi in November 2018. The overall themes of the four papers [1–4] are the planning of care, shared decision making, and interprofessional collaboration. In addition, there is the Lima Declaration 2018 entitled “Towards a Latin American Construction of Persons-Centered Integral Health Care,” which recognizes how important these concepts are to the development of general strategies for integrated health care with persons placed at the center of and as the goal of health actions. Reports from the Symposium on Person-Centered Medicine held during the 2018 World Medical Association’s Conference in Reykjavik and the First Peruvian Conference on Person-Centered Medicine add further evidence of the importance of these perspectives.

PERSON CENTERED MEDICINE FOUNDATIONS FOR MEDICAL EDUCATION

Background: The development of person-centered medical education is inscribed within an international programmatic movement toward a medicine focused on the totality of the person. This movement, with broad historical bases, has been maturing since 2008 through conferences with global health institutions, research projects, and academic publications. A key challenge in the application of person-centered medicine (PCM) to the practice of medicine has been the elucidation of its core principles and the development of operationalized measures that allows for assessment of the degree of person-centeredness in clinical care and medical education.

SUMMARY REPORT OF THE FOURTH LATIN AMERICAN CONFERENCE OF PERSON CENTERED MEDICINE

The Latin American Conferences of Person-Centered Medicine have been held annually since 2015 at the initiative of the Latin American Network of Person-Centered Medicine, in close collaboration with the International College of Person Centered Medicine and local Person Centered Medicine organizations, and with the cosponsorship of a range of regional and local health and academic institutions.

LA PAZ DECLARATION 2018 ON PERSON-CENTERED PRIMARY CARE: POPULAR AND SCIENTIFIC KNOWLEDGE, ECOLOGY, AND COMMUNITY PARTICIPATION

Resulting from the Fourth Latin American Conference of Person-Centered Medicine held in La Paz, Bolivia on September 7 and 8, 2018, organized by the Latin American Network of Person-Centered Medicine and the National Academy of Medicine of Bolivia under the auspices of the Latin American Association of National Academies of Medicine, the Peruvian Association of Person-Centered Medicine, the Representation in Bolivia of the Pan American Health Organization/WHO, the University of San Andrés (Bolivia), the Franz Tamayo University (Bolivia), San Marcos National University (Peru), and the International College of Person Centered Medicine.