Italian integrative medicine leader and GAHMJ editorial board member Paolo Roberti di Sarsina, MD, (pictured) has a passion for shaping the evolving concept of “person-centred” health and medicine. He is particularly interested in ensuring that the concept is inclusive of traditional, complementary and alternative approaches and practices. He is the founder of the Italian non-governmental organization entitled the Association for Person-Centred Medicine. He and his colleagues have published extensively on this theme and related matters. Some of those that are available in English are listed at the bottom of this post.
In his most recent publication, available via open access, “Person-centred healthcare and medicine paradigm: it’s time to clarify,” Roberti di Sarsina and his co-author Mariateresa Tassinari take a stab at defining what “person-centred” is and what it is not. To them, it is beyond a “holistic” view of the person: “To our way of thinking, that is simply the basic premise from which we must set out; it is not an achievement on which to preen ourselves.”
The author team offers a figure to define the multiple contributors to the scheme. For instance: “The person-centred medicine and medical paradigm is not only prevention but salutogenesis not prediction through costly genetic testing that could (potentially) contribute to an increased inequality in terms of health but also empowerment to the citizen.” In this care paradigm, “to foster health by a pro-active, pro-resilient health-generating approach marks a point of historic crux and transition.” They add: “From being an object of observation and welfare (to be ‘patched up’ and restored to his/her place of provenance as quickly as possible), the patient becomes an active and responsible subject, the true protagonist in the process of healing.”
Roberti di Sarsina and other colleagues took an earlier look at some of these issues in an article titled “Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine—person-centred medicine.”
Comment: Back in the 1980s in the United States, among the ways by which “alternative medicine” practitioners typically distinguished themselves was by their focus on what they called individualized care. To the physicians, the term was sometimes biochemical individuality. A revolt, in those days, from the term “patient” as object and top-down passive recipient of treatment also often figured in. Treating the whole person was the favored phrase. These views are fundamentally aligned with Roberti di Sarsina’s notions of what it means to have the human being in the center of care.
So there was great irony that in regular medicine the notion of “personalized” care finally arrived not via the eyes, bodies, and energetic presences of the human beings that face one in clinic, but rather on the multibillion-dollar back of the genome project. “Patient-centeredness,” likewise, arrived in regular medicine often as marketing initiatives when US hospitals became a more overtly competitive endeavor in the early 1990s. The focus on the patient also came as a response to safety issues rather than a more fundamental view that the best treatment meant engaging the whole person. Meanwhile, it is the cultural, familial, and personal predilections for selfcare and engagement, and for appropriate combinations of regular, traditional, or alternative approaches and practitioners that should be in the center of any method that deserves to be called “person-centered care.” Yet still in most of regular medicine, while we are seeing some excellent movement toward more meaningful integration in some systems, “TCAM,” as the writers put it—traditional, complementary, and alternative medicine—are still often merely tagged on, perhaps via a couple of boxes to check on an intake form. Thus, the importance of what Roberti di Sarsina and Tassinari set out to do is high.
Because the paper is about finding clarity, however, and indeed, in putting a stake in the ground in the broader medical use of the term, the authors would have been served by a more linear and step-wise progression of themes in the paper. For instance, I like the references to the person-centered intention in the World Health Organization work on traditional medicine and the Declarations of Beijing and Alma Ata. These lend the thesis global backing. Yet the references feel almost like a sort of “declaration-centered medicine” rather than “person-centered.” A lengthy sidebar on the role of the placebo in this form of medicine also increases a rambling quality already in the article. Some of the authors’ clarity may have been lost in the translation. Still, this is a great direction for not only semantic clarification but, more importantly, for re-establishing a claim to prior water rights to this potent paradigm. Person-centeredness begins with the person, not the gene.
At Roberti di Sarsina’s request, I provide these selected from a list of prior publications from his group linked to the Association for Person-Centred Medicine:
- The Contribution of Traditional, Complementary and Alternative Medical Systems to the Development of Person-Centred Medicine: the Example of the Charity Association for Person-Centred Medicine.
- Salutogenesis and Ayurveda: indications for Public Health management
- Traditional and Non-Conventional Medicines: the Socio-anthropological and Bioethical Paradigms for Person-Centred Medicine. The Italian context
- Tibetan Medicine: A Unique Heritage of Person-Centred Medicine
- The Social Demand for a Medicine Focused on the Person: The Contribution of CAM to Healthcare and Healthgenesis
- Meniere’s Disease Treatment: a Patient-Centered Systematic Review