Introduction to person‐centred medicine: from concepts to practice

The early roots of the concept of person-centred medicine can be found in the comprehensive notion of health and the personalized approaches to medical care discernible in both Eastern and Western ancient civilizations [1,2]. Other significant precedents include contemporary developments in clinical medicine and public health challenging an overemphasis on specific organs and disease and seeking to place the whole person at the centre of medicine [3]. The recent coordinated global effort towards person-centred medicine started with an inaugural Geneva Conference on Person-centred Medicine in May 2008. It involved the collaboration of major international medical and health organizations and a group of committed clinicians and scholars [4]. The Second Geneva Conference took place on 28 and 29 May 2009 under the auspices of the University of Geneva Medical School and the University Hospitals of Geneva organized by the World Medical Association (WMA), the World Organization of Family Doctors (Wonca) and the International Network for Person-centered Medicine (INPCM), in collaboration with the Council for International Organizations of Medical Sciences (CIOMS), the World Federation for Mental Health (WFMH), the World Federation of Neurology (WFN), the World Association for Sexual Health (WAS), the International Association of Medical Colleges (IAOMC), the World Federation for Medical Education (WFME), the International Federation of Social Workers (IFSW), the International Council of Nurses (ICN), the European Federation of Associations of Families of People with Mental Illness (EUFAMI), the International Alliance of Patients' Organizations (IAPO) and the Paul Tournier Association. The Conference had as principal purposes to examine and discuss key concepts of person-centred medicine and practical approaches for its implementation, to elicit useful initiatives on person-centred medicine and to engage international medical and health organizations on the Conference's theme. The Conference Organizing Committee was composed of J.E. Mezzich (World Psychiatric Association President 2005–2008), J. Snaedal (World Medical Association President 2007–2008), C. van Weel (World Organization of Family Doctors President 2007–2010) and I. Heath (World Organization of Family Doctors Executive Committee Member at Large). The Conference Secretariat was based at the International Center for Mental Health, Mount Sinai School of Medicine, New York University. Financial and in-kind support for the Conference was provided by the University of Geneva, the Paul Tournier Association of Geneva, Person-centered Medicine & Psychiatry Programs, Conference registration fees and the emerging International Network for Person-centered Medicine [5]. The Conference was opened by the Rector of the University of Geneva and the Vice-Dean of its Medical School, as well as by the members of the Conference Organizing Committee. All remarked on the tradition that was being established engaging Geneva as encounter point for the development of person-centred medicine. The first scientific session involved presentations of leaders and representatives of the International Alliance of Patients' Organizations, the International Network for Person-centered Medicine, the World Health Organization, the World Medical Association, the World Organization of Family Doctors, the Council of International Organizations of Medical Sciences and the International Council of Nurses. The presentation of policy statements and relevant institutional programmes reflected the value ascribed by these organizations to person-centred medicine. The abstracts of the presentations made at this and the following sessions of the Second Geneva Conference have been posted at the INPCM website, http://www.personcenteredmedicine.org. Eight special initiatives relevant to person-centred care were presented in the second session. The presentations were made by representatives of several major organizations collaborating in the Second Geneva Conference and other prominent work groups. The diverse experiences presented from a range of fields revealed substantive achievements and promising opportunities for a medicine of the person. Concepts and meanings of person-centred medicine were the subject of the third session. They focused on the role and worth of the person in medicine, the cruciality of sense of identity, empathy and engagement for optimal clinical care, and the value and impact of life experiences for the development in each individual of personalized medicine and health. The fourth session presented and discussed procedures for person-centred diagnosis. Particularly covered were the significance of multilevel explanations and diagnosis in medicine, the key features of a person-centred integrative diagnosis addressed to appraise whole health using standardized and narrative descriptions reflecting interactions among clinicians, patient and family, as well as the prospects for person-centred diagnosis in general medicine. A panel on programmatic contributions for person-centred medicine in a fifth session offered an opportunity for the presentation of brief statements by representatives of 12 collaborating organizations and groups from across the world. They attested to the relevance of person-centred approaches to medicine for an ample range of medical, health and social institutions. The sixth session, at the beginning of the second day of the Conference, discussed procedures for person-centred treatment and health promotion. These included general features of person-centred integrative care, the prospects for a person-centred medical home in the USA, and WHO perspectives on person-centred healthiness, social determinants and health promotion. Person-centred medicine for children and older people was discussed in the Conference seventh session. Such vulnerable populations represent particular challenges and opportunities from scientific and ethical viewpoints. The uniqueness and developmental sensitivity of the child were highlighted. Also pointed out were the complexity of health conditions in older people and the imperative need to attend to their values and perspectives. Training and research on person-centred medicine was the subject of the eighth session. Specific topics included the development of pertinent guidelines and curricula for person-centred clinical care, the assessment of an epistemologically based person-centred medicine at Ambrosiana University in Milan, training and research on communication for person-centred outcomes, and broad programmatic features and objectives of research on person-centred clinical care. The ninth conference session reviewed person-centred health systems and policies. WHO's new focus on persons for the development of more promising global health policies and systems, as affirmed by the latest World Health Assembly, was given pointed attention. Also discussed was the role of health informatics for the construction of personalized medicine and complex health care systems. Last but not least was a review of the role and documented value of the person for the conduction of health care, training and research The final tenth session presented a conference summary and outlined next steps. Among the general conclusions were (1) a commitment to the importance of person-centred medicine for the health of people, noting the participation of a vast array of important medical and health organizations, a wish to share and collaborate and an understanding of the importance of grasping opportunities in the field; (2) the growing availability of resources, including general concepts and procedures as well as teaching materials and research tools; and (3) the importance of fitting the above resources into health care systems and into particular health care encounters, with especial attention to person-centredness as an intrinsic quality rather than as an additional commodity, and the value of comprehensiveness, continuity, and attention to context as crucial features of good clinical care. Anticipated next steps included the following: (1) completion of a joint editorial to be published in an international journal; (2) preparation of a Second Geneva Conference Summary Report, (3) publication of a set of selected papers presented at the Second Geneva Conference; (4) collaboration with WHO on Person-centred Medicine topics related to the 2009 World Health Assembly Resolutions; (5) organization of scientific events relevant to person-centred medicine, such as a prospective New York Conference on Well-Being and Person in Medicine and Health; (6) planning a clearinghouse of Person-centred Medicine documents; (7) upgrading an internet platform to support archival, informational, communicational and programmatic needs; (8) organization of a Third Geneva Conference on Person-centred Medicine in early May 2010, prospectively focused on a team approach across specialties and disciplines; and (9) development of an International Network for Person-centered Medicine to stimulate the above activities and to organize initiatives on conceptual and ethical bases, diagnosis, clinical care, training, research, health systems and public policies. Proposals for future conferences included building bridges to the various specialties in medicine, the participation of different patient groups and the inclusion of representatives of additional health disciplines. Emphasis was made on consolidating the ideas from the first two conferences, and to use that for further work to enhance person-centred medicine. The Second Geneva Conference was distinctly perceived by its participants as a stimulating success in terms of food for thought and shared commitment to build a paradigmatic shift in medicine and health care. A Third Geneva Conference was widely anticipated as the next landmark in this unfolding process with the emerging International Network for Person-centered Medicine as the collaborative and flexible structure to coordinate and move forward a vision and programmatic efforts. In order to extend the impact of the Second Geneva Conference, a plan was arranged with the Journal of Evaluation in Clinical Practice to publish a selection of the papers presented at the Conference. The authors of this Introduction, members of the Board of the International Network for Person-centered Medicine, assumed editorial responsibility to work with the authors of the selected papers in upgrading them for publication. The papers are presented thematically ordered in terms of institutional and policy perspectives, clinical concepts and clinical practice. We hope they offer a valuable contribution to the process of building person-centred medicine.