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The new subjective medicine: taking the patient's point of view on health care and health


  • Sullivan, Mark


Calls to respect patient autonomy and produce patient-centered outcomes have recently brought the patient's point of view back into the center of clinical medicine. Bioethics has argued that patient values must be respected in health care decisions. But it has generally not questioned medicine's goals, including its definition of health. For bioethics, health has remained an objective biological fact. However, pressures to improve the cost-effectiveness of medical care have increased interest in the subjective health and quality of life of patients. Perceived health, health-related quality of life, and health-state utilities bring health assessment progressively closer to the patient's perspective. Now even death's harm to patients is qualified by the value patients place on their health state. Medicine's epidemiological transition from acute to chronic disease is thus prompting an epistemological transition from primarily objective to primarily subjective evidence of health and health care effectiveness. Now some of the most important patient outcomes, like patient choices before them, are valid because they are subjective. Pathophysiology is appropriately becoming a means to produce health as it is defined from the patient's point of view. The physicians' job description will be changed to focus on patients' lives rather than patients' bodies. Definitive evaluations of medical effectiveness will occur within patients' lives rather than within doctors' hospitals. This further incorporation of patient subjectivity should carry us well beyond informed consent and the other protections for patient autonomy bequeathed to us by bioethics.

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  • Sullivan, Mark, 2003. "The new subjective medicine: taking the patient's point of view on health care and health," Social Science & Medicine, Elsevier, vol. 56(7), pages 1595-1604, April.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:7:p:1595-1604

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    Cited by:

    1. Lehoux, Pascale & Poland, Blake & Daudelin, Genevieve, 2006. "Focus group research and "the patient's view"," Social Science & Medicine, Elsevier, vol. 63(8), pages 2091-2104, October.
    2. Miller, Nancy & Weinstein, Marcie, 2007. "Participation and knowledge related to a nursing home admission decision among a working age population," Social Science & Medicine, Elsevier, vol. 64(2), pages 303-313, January.
    3. Finn, Mark & Sarangi, Srikant, 2008. "Quality of life as a mode of governance: NGO talk of HIV 'positive' health in India," Social Science & Medicine, Elsevier, vol. 66(7), pages 1568-1578, April.
    4. Gisquet, Elsa, 2008. "Cerebral implants and Parkinson's disease: A unique form of biographical disruption?," Social Science & Medicine, Elsevier, vol. 67(11), pages 1847-1851, December.
    5. Christen, Regula Nelly & Alder, Judith & Bitzer, Johannes, 2008. "Gender differences in physicians' communicative skills and their influence on patient satisfaction in gynaecological outpatient consultations," Social Science & Medicine, Elsevier, vol. 66(7), pages 1474-1483, April.
    6. Oviedo, Enrique & Fernández, Andrés, 2010. "Information and communication technologies in the health sector: opportunities and challenges for the reduction of inequalities in Latin America and the Caribbean," Políticas Sociales 165, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL).
    7. Thompson, Andrew G.H., 2007. "The meaning of patient involvement and participation in health care consultations: A taxonomy," Social Science & Medicine, Elsevier, vol. 64(6), pages 1297-1310, March.
    8. Eissens van der Laan, M.R. & van Offenbeek, M.A.G. & Broekhuis, H. & Slaets, J.P.J., 2014. "A person-centred segmentation study in elderly care: Towards efficient demand-driven care," Social Science & Medicine, Elsevier, pages 68-76.


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