Fostering Physician‐Patient Partnerships: The Importance of Embracing the Ontological and Epistemological Understandings of Knowledge
Bibliographic record
Abstract
INTRODUCTION: Healthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist. AIM: We sought to shed light on the ontological and epistemological 'tensions' generated by the implementation, sometimes by imposition, of the concept of physician-patient partnership in medical practice. METHODS: This reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes. FINDINGS: Identifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies-neither is inherently superior to the other-are essential for a broader and concrete understanding of illness, its experience and its management. CONCLUSION: This exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all. PATIENT CONTRIBUTION: The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.087 | 0.072 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.012 | 0.073 |
| Scholarly communication | 0.032 | 0.028 |
| Open science | 0.003 | 0.026 |
| Research integrity | 0.008 | 0.011 |
| Insufficient payload (model declined to judge) | 0.004 | 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".