Patient-Based Medicine

PBM: Patient-Based Medicine

"The art of medicine is a literary art. One that requires of the practitioner the ability to listen in a particular way, to empathise, but also to imagine. To try to feel what it must be like to be that other person lying in the sick bed, or sitting across the desk from you. To try to understand the storyteller, as well as the story." Cecil Helman, GP

'Clean clear water transformed health in 19thC; clean clear knowledge will transform health in the 21st Century', Sir Muir Gray

Inspired by both Helman and Gray we aim to practise, and teach, what we apologetically call Patient-Based Medicine. 

For those unfamiliar with it, Suburban Shaman is a wonderful book by the late great GP Cecil Helman (obituary, BMJ2009:339;b2904). He made his name with Culture, Health and Illness but Suburban Shaman is an autobiographical celebration and affirmation of General Practice, an entertaining and funny read. Helman firmly believes in a non-medicalised whole-person model of care, in which the patient’s unique cultural background and circumstances are inseparable from their experience of illness. He sees many similarities with the role we play in the community with that of healers, or shamans, in traditional cultures. He writes ‘beyond the disease is the person, but beyond the person are always the time and place and particular circumstances in which they live and die’.  

We mention this here because NB Medical’s Hot Topics course is all about helping GPs with keep up with ‘the knowledge’: clinical evidence, guidelines and all the other new developments that come our way. We agree with Muir Gray, and believe we really do need to be aware of this information so that we can offer our patients the best treatments available, but all has to be interpreted in the light of the unique circumstances in which we and our patient find yourself.  EBM is often criticized for being reductive, de-personalizing ‘cook book’ medicine but  this is not so as its definition makes clear: ‘EBM is the integration of the best available evidence with our clinical expertise and our patients’ unique values and circumstances’ (EBM2007:12:1).  As patients we want our doctors to consider us as unique people, rather than conditions, and to try to understand us in our context. But at the same time we really do want them to know that if we turn up with Bell’s Palsy that 50mg of prednisolone for 10 days is an effective treatment. And, if we don’t know, where and how we can find the answer.

We at NB passionately believe in Patient Based Medicine. This is personalised, patient-centred care based on the best available scientific evidence. Our role is to try to understand our patients, to help them to make sense of their problems and to empower them to make informed choices. These choices should be evidence-based, but ultimately it’s ALWAYS the patient’s call.

Simon