Diary of doctor who dreamed of a patient-focused model

Abstract

In recent years, has arisen a need to develop new models of healthcare that seek to overcome the reviled hegemonic paternalism and combat the idea that medicine, on its way to reach an extraordinary scientific and technological level at the service of the progress of humanity, has left aside the vision and welfare of patients. In this context, Patient-Centered Models (PCM) has emerged, which advocate for "health care that respects and is sensitive to the needs, values ??and preferences of individuals, and ensures that patient values ??guide all clinical decisions."

In this article we analyze, from a critical perspective -confronting ideas that arise from a thoughful reading of the scientific literature with personal reflections emanating from the experience and with histories of clinical encounters-,  the fundamental principles of these models, their historical development, the dynamics of interest that hide and surround some of them, their essential components, the clashes between theory and practice, between organizations and individuals, between process and result, and between expectation and adequacy, and, in parallel, we will deconstruct concepts such as shared decision making and expert patient. Special emphasis is placed on the human aspects of healthcare, its essentially relational dimension, in the uniqueness of the clinical encounter as a common place where two experts, the clinician and the patient, collaborate or compete, and in the ethical dilemmas that dot that rich and complex relationship.