Logos, ethos and pathos in balance - the care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice.
Bibliographic record
Abstract
In a recent discussion paper, Miles and Mezzich described person-centered medicine (PCM) as a model of modern medical practice that has emerged from the intellectual currents of the past century. In this commentary, we consider what PCM has to offer as a model for the clinical encounter and for clinical judgement. The doctor-patient relationship is an important thread in a person-centered medicine that visualizes the clinical encounter as a dialogue between 2 persons. Person-centered clinical judgement is concerned with the individual clinical case and as such is integrative, context-sensitive, interpretive and circumstantial. A care model incorporating these elements of dialogue and individualized judgement is ideal for older patients, for whom population-level guidelines are often inapplicable, who are often dependent on other persons and who are heterogeneous in their needs. As such a model, PCM is the dialectic synthesis arising out of decades of conflict between patient-centered medicine, and its antithesis, evidence-based medicine. If PCM is to progress from a prescriptive model to a descriptive model of modern medicine, its proponents must claim its philosophical commitments, keeping in mind that a model is fundamentally instrumental and not necessarily always literal. Medicine should look to a care model that is person-centered in the ways described here and that keeps the rational, virtuous and humane elements of practice in balance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.009 | 0.096 |
| Scholarly communication | 0.016 | 0.018 |
| Open science | 0.003 | 0.011 |
| Research integrity | 0.012 | 0.021 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".