The patient: the beginning of it all

by Elena Rocca, Better Evidence for Better Healthcare Manifesto

We often think of the perfect medical research and health care system as a system that puts patient’s care as the final aim of a long process. In a way, this is hardly controversial: patient’s interest must be prioritized over commercial interest, for instance. Research hypotheses, funding, experimental designs ought to be developed with a special consideration that they are meant to be primarily useful for the patient. Important steps are being taken in this direction.

This concept, however, must be somehow adjusted. While patient’s healthcare motivates medical research, there is nothing “final” about the clinical meeting between practitioner and patient. Quite the contrary: each of such encounters is potentially the beginning of a new hypothesis, a challenge for established paradigms, and the springboard for broadening medical knowledge. This is not difficult to believe if we think about history of medicine.

Several have argued the value of patient-centered medicine for the final purpose of an improved clinical decision making, patient care, and clinical ethics. Few talked about the fact that a patient-centered clinical approach has also a big epistemological value: it is the best chance available for the advance of causal knowledge in medical research. Expansion of medical knowledge does not happen as a straight line, with the patient at the end of it. It is a continuous circle of trial and success/ failure, where evidence from clinical cases are looping back to pre-clinical and clinical research. The more attention is given to the clinical cases, therefore, the more chances we have to improve research.

From a practical point of view, what does it entail? First of all, the clinical interview takes on a crucial role, not only for the patient’s wellbeing, but also for the whole medical community. This important process of gathering clinical evidence should not be left to individual skills and improvisation. Medical schools should teach patient-centered models of clinical communication, and should stress their key value. Second, clinical evidence should be collected in databases and networked with the medical/ research community. Third, researchers should recognize the primary role of patient-centered evidence for the corroboration, challenge, and advance of causal knowledge.

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