NEJM Audio Summary - March 1, 2012

Excerpted Script

Defining “Patient-Centered Medicine”, a perspective article by Charles Bardes. From Weill Cornell Medical College, New York. 

What is the proper relation between the doctor's and the patient's experiences of illness? Between a scientific understanding of disease, whatever the science of the day may be, and the subjective phenomenon of being sick? Between the subspecialist and the general physician? Between cure and care?“Patient-centered medicine” is the newest salvo in these ancient debates.

As a form of practice, it seeks to focus medical attention on the individual patient's needs and concerns, rather than the doctor's. As a rhetorical slogan, it stakes a position in contrast to which everything else is both doctor-centered and suspect on ethical, economic, organizational, and metaphoric grounds.

Patient-centered medicine is, above all, a metaphor. “Patient-centered” contrasts with “doctor-centered” and replaces a Ptolemaic universe revolving around the physician with a Copernican galaxy revolving around the patient. The flaw in the metaphor is that the patient and the doctor must coexist in a therapeutic, social, and economic relation of mutual and highly interwoven prerogatives. Neither is the king, and neither is the sun. Health relies on collaboration between the patient and the doctor, with many others serving as interested third parties. Patient and physician must therefore meet as equals, bringing different knowledge, needs, concerns, and gravitational pull but neither claiming a position of centrality. 

語彙

• the Ptolemaic system /ˌtɑləˈmeɪɪk ˌsɪstəm/
• Copernican system /kəˈpərnɪkən ˌsɪstəm/
• flaw /flɔ'ː/ 欠陥、欠点、不備
• prerogative /prirɑ'gətiv/ 特権