Historical Overview of Person Centered Medicine

Abstract

Pre-history: From the age of the Neanderthals, care for illness and injury became widespread and depended on the close social bonds developed within groups and the concern for each other’s well-being. With few specific therapeutic measures available, mutual social care appears to have been the mainstay for the protection of life and the promotion of well-being.

Early history (ancient civilizations): Evolution into a recognizable physician did not occur until observations were recorded and knowledge could be shared and distributed within a structured society. The first significant records of more formalized medicine appeared in China around 2500 BC. A relatively seamless exchange of culture accompanied trade across land masses. In the second century BC, during the reign of the Babylonian King, Hammurabi, legal aspects of regulating medical malpractice within a society were recorded. The general thrust of the Code of Practice was protection of the individual and that the physician should do no harm. In India, Hindu Ayurvedic medicine encouraged physicians not to undertake unlawful acts during the course of their medical duties. The formal development of an ethical code of medical practice in the West, can be traced to the time of Hippocrates 462–370 BC. His Code of Practice or ‘Oath’ emphasized a need for confidentiality and non-malfeasance. Also crucial are Aristotle’s Eudiamonic and Nicomachean Ethics, seen as reflecting a person-centered medical approach. Further important for medicine and health among early civilizations are the Andean worldview (ethical, solidary, conceptualizing health as equilibrium among the internal, the social and the natural worlds) and the South African (e.g., Ubuntu) humanism.

Middle age: The culture and medical practices of the ancient Eastern civilizations, reached the Seleucid Empire—a Hellenistic State in Western Asia—through trade and Westward migration from the third century BC onwards. Then from the second century BC the Sassanid Empire—the last Persian dynasty before Islam—came to benefit from this influx of culture from the East. Records of medical and surgical cases in Rome, during the first century AC exist, including those of Galen, a native of Pergamum in Asia Minor who went to practice in Rome. Galen maintained that there were no separate mental and physical aspects of disease and argued that as the ‘soul’ is affected by physical influences, it must be an integral part of the body.

The physicians Razzes and Avicenna centered on Baghdad contributed to the ‘Golden Age’ of Arab or Islamic medicine from eighth to thirteenth century. This was accompanied by the emergence of the world’s first hospitals. The Islamic invasion of the Iberian Peninsula in 711 AC took this wealth of knowledge across civilizations and continents to Northern Europe. Maimonides (1135–1204 CE) was a Jewish physician who lived in Spain under Arab rule which afforded intellectual freedom. He proposed a Prayer or Code of Practice which aimed to prevent attempts to ‘frustrate the wisest purpose of our Art’.

Plague was inflicted on Egypt, as is recorded in the Book of Exodus. Subsequently, travel and trade led to the introduction of disease and plagues between communities. Following the Crusades, leprosy was introduced into England by the returning Crusaders. This gave rise to ‘leper’ hospitals such as St. John’s in Oxford and St. Nicholas’ in Canterbury. The first hospital in the UK to look after patients with more general medical problems was St. Bartholomew’s in London founded in 1123.

The invention of printing by Johannes Guttenberg in 1440 was a development of enormous importance for the dissemination of general, professional and scientific information.

Modern and contemporary ages: The rediscovery of the person in the arts and the cultivation of the humanities denote the profile of the Modern Age. Its later phases involved the development of illustration and rationalism, which contributed to the bases of the French Revolution and the emergence of the Contemporary Age.

A period of great advances and discovery was ushered in from the seventeenth century. Observation, measurement and classification, made possible by technical advances in many fields. In optics this led to the development of the microscope. Wilhelm Roentgen’s discovery of X-rays in 1895 in Germany and subsequent demonstration of the properties of radioactive isotopes by Marie Curie in Paris during the early twentieth century opened a whole new field of therapy. This eventually led to CT scanning and body imaging.

When Howard Florey and EB Chain, both immigrants to the UK, searched for possible antibacterial agents before World War Two, they rediscovered Alexander Fleming’s stray contaminant, penicillin. This led to a worldwide search for other agents. The impact of the discovery in 1953 of the double helix building blocks of DNA by Francis Crick and James Watson has given rise to an enormous amount of research, including that on the completion of the Human Genome. This has given insight and understanding not only for medical care, but also of evolution, while revealing the complexity and diversity of diseases and the potential value of whole person approaches.

The introduction of scientific and experimental methodology in clinical medicine in the nineteenth century increased demand for experimentation on human subjects, particularly in bacteriology, immunology and physiology. As a result of injury to some patients, regulations were introduced to exercise some control. The outcome was the Declaration of Helsinki by the World Medical Association in 1964.

The escalating costs of health care related to the advances of medicine has put an emphasis on health systems, which are becoming increasingly dominant, often at the expense of humanism in patient care. In response, physicians such as the spiritually-minded Paul Tournier from Switzerland and psychologists and educators such as Carl Rogers in the United States, championed the centrality of the person in health care.

Partly as reactions to reductionistic Flexnerian medical education and “evidence-based-medicine” models and dehumanized health systems, more encompassing models and programmatic movements that articulate science and humanism have emerged under the general term of person centered medicine. Such programmatic movements, such as that built by the International College of Person Centered Medicine, have partnered with global health institutions such as the World Medical Association concerning ethical commitment in healthcare, and with the World Health Organization and its regional branches concerning strategies for persons- and people-centered health services.