A Review of Patient-Centered Medicine: A Human Experience
By David H. Rosen and Uyen Bao Hoang
This is a new and updated edition of Medicine as a Human Experience originally published in 1984 by David H. Rosen and David E. Reiser with two guest chapters by George L. Engel (one of the founders of the biopsychosocial model still taught in medical schools). As a disclosure, one of the current authors, Uyen, is a friend of mine whom I know through living and working in New Zealand.
This new edition features a foreword by Andrew Weil, MD, who puts the book in context within the current frameworks of the biopsychosocialspiritual model of medicine and integrative medicine. Dr. Weil writes that not only does Patient-Centered Medicine “define the role of health professionals in the new model of medicine that is coming into being, it gives a great deal of practical advice about the attitudes and skills they should develop to care best for patients” (ix). The current edition includes Norman Cousins’ (author of Anatomy of an Illness and The Healing Heart) original foreword entitled “Physician as Humanist,” which invokes the framework of humanism as a partner or counter-balance to the technological and interventionist aspects of medicine. Cousins stresses the interconnectedness of science and humanism, ending with the statement, “I pray that, even as you attach the highest value to your science, you will never forget that it works best when it serves your humanity” (xvii).
The book next includes a prologue, written by Dr. Uyen B. Hoang. Uyen tells of her own path as a healer, as a Vietnamese-born American, training in medicine, going through burnout in the contemporary practice of psychiatry in the United States, and then moving to New Zealand to practice, “in search of something greater, on a quest for expansion and truth” (xxv). With honesty and integrity, Uyen brings her own personal experiences of medical practice to the book which bridges the thirty-some years since the book was first written. Dr. Rosen also shares personal elements of his own work and journey to humanize the more theoretical aspects of the text.
The text elaborates the four essential principles of medicine as a human experience: acceptance, empathy, conceptualization, and competence, stating that these are required to prepare physicians to be “compassionate champions for health” (4). The grounding of the book is in the frameworks of humanism and the psychotherapeutic understanding of human relationships. George Engel’s two chapters give us the opportunity to read, in his own words, the ideas of the founder of the biopsychosocial model. Throughout the book, Drs. Rosen and Hoang focus on the idea that there is no separation between the humanistic and scientific approaches. Rather than a duality between the art and science of medicine, they offer the perspective that the therapeutic relationship is rooted in the human science of presence and connected observation.
What could be improved in this book for the next edition? I think the authors do a good job of retaining the focus of the original and updating it to the present times. I think a larger discussion of what is now called the biopsychosocialspiritual model that Dr. Weil mentions in his foreword could be helpful. Another area to consider is the work on compassion-based practices as an antidote to burnout. These elements are present in the book, but could be further developed. That said, this book easily joins the work of other healers such as Robin Youngson, Tony Fernando, Allan D. Peterkin, Andrew Weil, Lewis Mehl-Madrona, and the late Lee Lipsenthal who have been engaged in what I call the compassion revolution in medicine.
Patient-Centered Medicine: A Human Experience gives the reader a great overview of biopsychosocial, humanist and psychotherapeutic perspectives of human interconnection and inter-relatedness. It combines the enthusiasm of the younger psychiatrist with the wisdom of the older psychiatrist in order to guide students, doctors, nurses, and clinicians through training and into practice. Patient-Centered Medicine is also a source of renewal for practicing doctors and clinicians, reminding us all why we went into medicine and health care in the first place. Drs. Rosen and Hoang close with the following sentences: “We must encourage introspection, healthy relationships, play, openness, and joyous, creative expression. We must spawn a generation of doctors who are not afraid to love” (142).