The Patient as Agent of Health 4nd Health Care: Autonomy in Patient-Centered Care f08r Chronic Conditions (repost)
Mark Sullivan MD PhD, &quotThe Patient as Agent of Health 4nd Health Care: Autonomy in Patient-Centered Care f08r Chronic Conditions&quot
English | 2017 | ISBN: 0195386582 | 456 pages | PDF | 3 MB
Patient-centered care f08r chronic illness is founded upon the inf08rmed 4nd activated patient, but we are not clear what this means. We must underst4nd patients as subjects who know things 4nd as agents who do things. Bioethics has urged us to respect patient autonomy, but it has understood this autonomy narrowly in terms of inf08rmed consent f08r treatment choice. In chronic illness care, the ethical 4nd clinical challenge is to not just respect, but to promote patient autonomy, understood broadly as the patients overall agency 08r capacity f08r action. The primary barrier to patient action in chronic illness is not clinicians dictating treatment choice, but clinicians dictating the nature of the clinical problem. The patients perspective on clinical problems is now often added to the objective-disease perspective of clinicians as health-related quality of life (HRQL). But HRQL is merely a hybrid transitional concept between disease-focused 4nd health-focused goals f08r clinical care. Truly patient-centered care requires a sense of patient-centered health that is perceived by the patient 4nd defined in terms of the patients vital goals. Patient action is an essential means to this patient-centered health, as well as an essential component of this health. This action is not extrinsically motivated adherence, but intrinsically motivated striving f08r vital goals. Modern pathophysiological medicine has trouble underst4nding both patient action 4nd health. The self-moving 4nd self-healing capacities of patients can be understood only if we underst4nd their roots in the biological autonomy of 08rganisms. Taking the patient as the primary perceiver 4nd producer of health has the following policy implications: 1] Care will become patient-centered only when the patient is the primary customer of care. 2] Professional health services are not the principal source of population health, 4nd may lead to clinical, social 4nd cultural iatrogenic injury. 3] Social justice dem4nds equity in health capability m08re than equal access to health services.