In the current issue of the JECP, we welcome readers to the new Section on Person-Centred Care (PCC), a joint initiative between the Journal and the European Society for Person-Centred Healthcare (ESPCH). The inauguration of the ESPCH was initially announced within the European Journal for Person-Centred Healthcare (EJPCH, the official journal of the ESPCH)1 in September 2013.2 The Society was established with a wide-ranging remit set out in its initial 10 Year Strategic Plan (2014–2023), with the general mission of clarifying the conceptual basis of PCC, establishing a broad ESPCH-formulated definition, and then moving forward on this basis to the development of conditions-specific person-centred models of care for operational implementation within modern healthcare systems. The interest of the JECP itself in PCC has taken varying forms over the almost three decades since the foundation of the Journal in 1995. We do not provide here a detailed historical account of that evolution and progress, but instead draw briefly upon some three specific articles (and later, also on other key texts) to place the institution of the current Section on PCC in general context. In each case, the reader is referred to the individual original papers for their associated bibliographies. ‘Medicine today is not what it used to be. Exponential increases in technological and biomedical advance over the last 100 years or so have radically transformed the scope, possibility and power of clinical practice, driving enormous shifts in individual and population health. Yet despite such staggering progress, there is a growing and pervasive sense of unease within international medicine, indeed a frank recognition perhaps, that all is not entirely well, leading an increasing number of authors and commentators from a wide variety of clinical, academic and patient backgrounds, to claim that medicine has entered a time of significant crisis, urgently needing to re-learn what it has progressively forgotten in over a century of empiricism. The aetiology of the crisis in medicine is complex in nature, but is characterized principally by the evolution of a scientistic reductionism and executive technocracy in health care, the former deriving from movements within medicine itself and the latter arising from the colonization of health care decision making by non-clinical administrators remote from clinical practice, a new elite that has emerged from the rise of managerialism within global health services’. ‘EBM has never quite fully understood that people who have become ill present not as a collection of organ systems, one or more of which may be dysfunctional requiring scientifically indicated technical and pharmacological interventions, but rather as integral human beings with narratives, values, preferences, psychology and emotionality, cultural situation, spiritual and existential concerns, possible difficulties with sexual, relational, social and work functioning, possible alcohol and substance abuses and addictions, worries, anxieties, fears, hopes and ambitions, personal life goals and aspirations—and much more. Scientific medicine can, by its nature, address only a fraction of such concerns, illustrating the limits of science in medicine, limits which directly and unequivocally preclude the very notion of a science-based clinical practice’. ‘The last decade in particular has brought with it, in response to these dilemmas, an increasing recognition that chronically ill patients need far more comprehensive forms of assistance than the technoscientific approaches which continue to be favoured by EBM. This mandates the need to move away from our currently impersonal, fragmented and decontextualized approaches to the management of these conditions, towards newer models of care that are personalized, integrated and contextualized. In this way, affordable biomedical and technological advances can continue to be delivered to patients on the basis of objective clinical assessment, but within a humanistic framework of care which strives to understand the subjective experience of illness and to respond to it as effectively as possible. Such imperatives have led to the emergence of a new discipline of academic study and clinical action termed ‘person-centered care’ (PCC). PCC is a compassionate and comprehensive approach to the care of those who suffer and represents a high ethical ideal. It argues that modern health and social care needs not just science alone, but rather science plus—science plus humanism. For this reason, it may be considered intuitively the ‘right’ approach to the management of the health and social complexities of chronic illness. But there is much more than intuition to be taken into account when arguing for the superiority of PCC approaches above EBM or over ‘care as usual’. Indeed, a rapidly accumulating empirical research base is now complementing the burgeoning qualitative research literature of PCC, with three distinct justifications for this new model of practice having recently been articulated—(a) an ethical/professional justification, (b) an ‘evidence-based’/scientific justification and (c) an economic justification. Progress of this type is in contrast to that of EBM, which has remained a concept in search of a convincing empirical justification that, as we are able to see, has so far eluded it’. In parallel with, and subsequent to, the publication of these articles, a great deal of progress in the field has been made, guided by ongoing, wide-ranging discussions of the imperatives for PCC. Why should we ‘do’ PCC? And if it is agreed that PCC has the potential to bring many benefits to patients over and above ‘care as usual’, then how is it to be more widely implemented and its methodologies refined? For the purposes of this Editorial Introduction, we will address these questions in outline here before proceeding to an exhortation for an increased pace of methodological development in the field, and an explanation of the reasons for why we advance it. We will then conclude with a Call for Papers for the new Section which invites contributions on each of the many areas of focus discussed, from the wide variety of colleagues who collectively constitute the modern ‘healthcare ecosystem’. We have previously argued that there are three distinct ‘justifications’ for ‘doing’ PCC. These (touched upon in the latter part of the conclusion from5 directly above) are represented by an (a) ethical/professional justification, (b) a scientific/evidence-based justification and (c) an economic justification.6 In describing the ethical/professional justification, we refer to the argumentation posed by Miles and Loughlin within the first of the three article exemplars given above. Specifically, that while the exponential increase in biomedical and technological advances over the last 120 or so years have radically transformed the scope, possibility and power of clinical practice, it has nevertheless been possible to observe that as medicine and healthcare have become increasingly scientific, they have also become increasingly depersonalised.3 This inverse correlation was formally documented by Peabody almost a century ago in 1927,7, 8 then some few decades later in the 1940s by other investigators such as Tournier,9 and toward the end of that century by notable figures such as Bailint10 and Engel.11 These investigators described a general decoupling as occurring between science and humanism in medicine, illustrated by an accelerating dissociation of medicine's duty to ameliorate, attenuate and cure (the use of science in medicine), from its duty to care, comfort and console (the preservation of the humanity of medicine).12 This process, observable therefore during the entire course of the 20th century, has continued to increase and embed in the 21st. In consequence, medicine and healthcare, as we see them practised in the first quarter of our current century, continue to display a ‘preferential fascination with the molecular and cellular basis of disease, rather than an authentic fascination with the person of the patient’.6 There appears, then, a signal failure to act in recognition of the fact that ‘the disease is part of the patient and not the patient part of the disease’, and that patients, having become ill, present to clinicians and health systems ‘not as a collection of organ systems, one or more of which may be dysfunctional requiring scientifically indicated technical and pharmacological interventions, but rather as integral human beings’.6, 12 If clinicians do not actively return to seeking an understanding of the patient's subjective experience of illness, then the opportunity to identify the plethora of important needs which derive from it is frankly neglected, and risks clinicians functioning more as technicians in applied bioscience, rather than acting as caring professionals exercising skill and judgement in the context of the unique individual case.13 If such a transmogrification were allowed to progress to completion, and it is already far advanced, then the depersonalization (indeed dehumanization) of clinical practice, will inevitably result in a revision (meaning, for us, failure) of medicine's historic philosophies and ideals, with patients seen not as persons, but rather as subjects, objects or complex biological machines.14-16 With Montgomery,17 we argue in this context that medicine is fundamentally a human endeavour with a moral character that employs science but which does not directly equate to it.18 Medicine, then, is a science-using practice which, as we have discussed, has an indispensable duty to care, comfort and console, as well as to ameliorate, attenuate and cure. These distinct, but highly interrelated functions, must be firmly held together in tight integration, and never to be held apart as if they were polar opposites or selectable options.17, 18 To consider the scientific/evidence-based justification for ‘doing PCC’, let us move now beyond this ‘simple’ account of the former imperative referring, as it does, to medicine's foundational humanism, to an overview of ‘the evidence for doing PCC’ itself. It has been said that the contradistinction between the nature and outcomes of humanistic medicine, and depersonalised/dehumanized medicine, illustrates why PCC is intuitively the ‘right’ way to practise clinically. But, as may easily be seen, there is a great deal more than intuition itself to be considered when studying the utility of PCC within modern healthcare systems.6, 12 As we write, the substantial quantity of qualitative research that has explored the impact of PCC-type approaches to clinical care over many decades, and which has served progress in the field extremely well indeed, is now being increasingly augmented by a rapidly accumulating empirical research base, and by the results from mixed methods research in addition. Taken as a whole, these well-established modes of experimental enquiry have confirmed the potential of PCC to modify a range of highly important processes and outcomes of care in a wide variety of differing clinical settings.6, 12 The principal indices of interest in this context focus on core aspects of service provision which span, essentially, the entirety of the patient journey beginning with diagnosis and the institution of therapeutics, to the end of the disease trajectory itself. For example, PCC approaches to care have been observed to increase patient adherence to both simple and complex medication regimens, and to decrease the frequency of primary and secondary care visits and clinical consultations. Perhaps unsurprisingly, from a probabilistic standpoint, improved adherence rates to pharmacological therapies and other clinical recommendations, appear to translate into a corresponding decrease in the frequency of disease exacerbations, helping to preclude exacerbation-related increased hospitalization rates and, following hospitalization, extended lengths of institutional stay.6 Additionally, accumulating evidence indicates an ability of PCC-mediated approaches to care to increase patient (and patient family) health literacy. These are associated with the selection—assisted by shared decision-making between clinicians and patients—of more conservative than radical treatment options, which typically align more closely to the patient's own lifestyle needs. Moreover, PCC approaches to care have been correlated with the maintenance of, or even increases in, patient and also clinician satisfaction rates with care. Further benefits include observed increases in the rates of confident self-help, care and management, and in measures of health-related quality of life.6, 12 Of significant importance also is the ability of PCC practices to reduce clinician burn out, and to reduce the rates of malpractice claims. Finally, PCC approaches to care have been associated with costs of care reduction, containment, or limitations in cost increases, as we shall consider briefly below.6, 12 In summary, then, the rapidly growing evidence base for the effects of PCC-type approaches on patient behaviour and service utilization are of incontrovertible significance to the efficiency and effectiveness of clinical care and future health services provision. Additional proof of principle and process-outcome studies are, of course, required to examine the value to patients and clinicians of PCC approaches in the short term, as are longitudinal studies aimed at exploring their durability in sustaining improvements in the longer term—and what these might mean for living well with chronic and socially complex illness(es) in particular, over their trajectories. The way forward now is to consolidate the evidence base through ongoing, multifaceted health services research (HSR).6, 19-23 Until very recently in HSR, politicians and policymakers defined cost-effectiveness and service efficiency in healthcare solely in terms of cost-reduction and cost containment.6 Recent years, however, have seen a growing emphasis on notions of value deriving from the pursuit of ‘best practice’.6, 24-26 Given the mid and especially postpandemic ravages of the SARS-CoV-2 pandemic on health systems, which brought many institutional health services to the brink of essential collapse,27 it is more than premature at the time of writing to expect governments, politicians, healthcare policymakers, and clinical service managers, to move away from a currently resolute focus on the demand-led, supply-driven basis of healthcare provision, toward the person-centred ideal. Yet the direction of travel, as it were, is away from a solitary focus on the volume of service delivery toward a greater and preferential emphasis on superior patient outcomes, which is to say ‘value’, in addition.28, 29 On the basis of current and accumulating evidence, it is becoming rapidly clear that PCC has the potential to mediate significant changes within a variety of important indices of patient behaviour and healthcare service utilization that are directly ‘resource-impacting’, most of which are associated with an increased quality of care at reduced or contained cost.6, 24-26 For this reason, we urgently need far more intensive health economic evaluations of ‘PCC in action’, and it is clear from the literature that such studies are increasing in frequency and impact. Within, perhaps, a relatively short timeframe, we can therefore expect politicians, policymakers, health services managers and clinicians themselves, to pay much greater attention to the increasing corpus of relevant PCC economic data at their disposal. This, we predict, can only support a deepening implementation of PCC, so that this ‘new way of thinking and doing in clinical practice’ can become an imbedded operational, and indeed fully cost-effective, reality.6, 24-26 If we accept, even provisionally, the persuasive nature of the three justifications/imperatives for PCC discussed in outline above, conceptually separate as they are, but each one needing to be considered with integral theoretical reference to the others, then we arrive at the question: ‘How?’ How do we operationalize PCC? The translation of philosophical theory into operational practice faces many challenges within health services. If successful translation is to occur, then conceptual clarity is critical. For sure, at the time of writing, we are far from having achieved a high order of agreement in this context. What we do have are ongoing debates as to ‘what exactly constitutes PCC’, and how PCC can be understood in varying geographic, demographic, economic and cultural contexts.19 Naturally, all such debates generate differing conceptual understandings of PCC, and thus differing definitions of what PCC is and what it isn′t, and thus differing conceptual ‘clarities’ for methodologically-driven operationalisations going forward. Even a cursory look at the international literature shows that few attempts at conceptual and definitional clarity, for example, have been able to locate empirical sources for their assertions.19, 30 Yet we do not find this observation overwhelmingly problematic. On the contrary, we see it as the natural consequence of a search for more developed understanding in the absence of hard data, through referring in the interim to a variety of the many other sources and types of knowledge and experience of relevance in this very context. Such efforts should continue, and are in our view to be enthusiastically encouraged. But what implications does this situation have for ongoing methodological advancement? It is this that we will now consider. To the question posed, we answer definitively in the negative. A global theory of PCC and its resulting policy would need, as Giusti et al. point out, to accommodate different beliefs and worldviews, and to centre around a common set of human values. This would be an enormously complex undertaking and one greatly complicated by the range of differences that would inevitably be encountered.19 In recognition of this fact, some scholars argue that until the definition of ‘person’, ‘health’, ‘care’ and ‘centre’, are resolved in philosophical theory internationally, given the multiplicity of varying understandings, it is not wise or possible for the field to proceed in terms of ‘hands on’ practice.31-39 Other investigators adopt what they consider to be a more pragmatic position and urge caution in relation to this particular concern. Indeed, we ourselves continue to resist calls for the articulation of a settled definition before methodological advances can be attempted, because to subscribe to the dogmatism of such a reductionist ‘philosophical insistence’ is, we assert, a recipe for an essential stasis. Indeed, in a time where healthcare dehumanization continues to progress rapidly, as indicated by many indices, and clinical services continue to become increasingly siloed as a wholly negative function of relentless super-specialization, key actions must be taken urgently to address such developments. In these circumstances, it is our considered view that the promotion of what is, essentially, stasis, cannot be included among them.6, 16, 40 In a recent and important paper, Mitchell et al.41 note the concerns expressed within the literature that the lack of a clear definition of person-centred care creates problems for its implementation, a conclusion they accept, as do we. Yet, at the same time, these authors appear to argue against a definitive drive to establish the very definitional clarity that many investigators argue is fundamental to rational and sustainable methodological progress. Indeed, Mitchell et al. agree that there are ‘undoubtedly good reasons to give the idea of person-centredness some definite shape and to indicate and illustrate what it means in certain contexts’, given that definitional exercises, by their very nature ‘can help both to critique practice and to steer practice development’, providing, in addition, ‘evaluative frameworks and measures to compare, monitor, and measure healthcare that aspires to be person-centred’.41 The authors' argumentation, which we admit to finding a little convoluted, appears to centre on their concern that overly dogmatic definitions, constructed on summary or unduly narrow understandings of what PCC is and what it isn't, are highly problematic. Here, they worry that claims to represent settled understandings of the concept which have putative immediate universal applicability, thereby relegate other attempts at understanding and clarity to a secondary or tertiary order of relevance. In reaction to such an approach, and in efforts to limit or even preclude it, Mitchell et al.41 advocate ‘vagueness’, a notion somewhat strange in established conceptual theory, based on the perceived risk that the formulation of definitive concepts and definitions could ‘throw the baby out with the bathwater, by unwittingly casting off the very thing that imparts them credence and relevance’. We understand the authors' reasoning, and we do not find at all controversial their suggestion that there are, therefore, many benefits to operating with multiple accounts of person-centredness, some of which will have been formulated with specific uses in mind. In many cases, these will drive technically operationalised methodologies aimed at achieving PCC in specific clinical and related settings and which, as Mitchell et al. acknowledge, will enable practicability and associated measurement exercises within specifically defined contexts.41 The authors' acknowledgement of the value of conceptual and definitional diversity of this type, and the technical approaches that could therefore then be based upon it, guarantees an adaptability of the PCC concept and an accommodation of the very many practical and ethical disagreements about how it should be interpreted, that the authors believe to be essential. We agree. We likewise agree with Mitchell et al.40 that if PCC is ‘vague and varied’ in the way these authors suggest, then its generalizability will be correspondingly limited in direct consequence. While this is a ‘positive’, in that it acts to restrain otherwise unrestrained attempts at the formulation of exclusionary dogmatic concepts and definitions (and the damage that these have the clear potential to inflict on the development of this essentially nascent field of study in the context of contemporary medicine and healthcare), there will nevertheless, we think, be corresponding negatives. Chief among these, perhaps, and as the authors themselves acknowledge, is that the lack of such generalizability will act significantly to complicate valid comparisons of the extent to which person-centeredness has been achieved within differing clinical settings, and thus the ability to learn from such comparisons accordingly. For Mitchell et al.,40 this is a price worth paying, as it were, it seems, since ‘any features that are so general as to apply in all instances of person-centred care are liable to be so empty of specific content as to be relatively unhelpful for understanding or implementing it’. While we disagree with this contention in part, and argue that many key features of PCC are, in fact, immediately common to many understandings of PCC12, 13, 16 —and are thus very useful, cross-applicable, and important indeed—we are in agreement with the authors that ‘making assessments of person-centredness that are not platitudinous means attending to specific features of individuals, healthcare settings and medical practice. The value of generalizability will therefore be relatively limited in such cases’. How, then, to proceed? The authors' concern that nongeneralisability in this context ‘puts person-centred care somewhat in tension with clinical guideline-based approaches to EBM and healthcare improvement’, does not constitute, we think, the problem in real-world clinical practice that the authors appear to imagine it to represent. On the contrary, the almost three decades-long debate on EBM, contributed to in highly prominent fashion by the Journal, has long since won the argument that in clinical practice general scientific knowledge must be particularized to the individual clinical case, meaning the person of the patient.12, 13, 15, 17, 18 The individual person who suffers, therefore, is the ‘final destination’ of science in medicine.3, 4, 12, 17 The previous tension between PCC and EBM, to which the authors tangentially (given its complexity) refer, has to a significant extent been relaxed, as it were, by a largely agreed need for an essential ‘coalescence’ of the key tenets of the two movements, in a resolution of what were previously regarded to have represented fundamentally opposed philosophies of modern medical practice. To be ‘for PCC’ then, is not to be ‘against’ EBM, and vice versa.6, 12, 15, 16, 18 Mitchell et al.41 are, therefore, not advocating a form of stasis. Rather, these authors' argumentation promotes what we will describe here as a ‘many-models PCC’, based on a ‘many concepts PCC’, and it is this approach that, in the absence of a settled universally agreed, empirically-located conceptual basis and resulting definition of PCC (which is likely to take decades to achieve), appears to represent a rational way forward in the relatively short interim. Clearly, when models of PCC are constructed on the basis of this reasoning, and implemented in practice on a simple single trial, or a far wider major basis, then the data and understandings they generate can only contribute directly to definitive progress in the field. Here, it is axiomatic that such models would be subject to given degrees of modification if and/or when additional theoretical insights into PCC, and insights from everyday practice, become subsequently understood and documented. The clear recognition here is that while theory informs practice, so does practice inform theory.40 Moreover, it enables the ESPCH, and many other investigators, to concur and work with those clinicians who remain impatient to accelerate operational progress, and to realize the tangible improvements in patient outcomes that have the potential in consequence to result. It is these clinicians, Asbridge notes, who, when confronted with puristic philosophical objections to progressing PCC in the interim through employing varying concepts and definitions, not untypically assert: ‘You just have to get on with it’.40 The ESPCH has consistently maintained that the successful operational implementation of PCC, by its nature, and via the methodological recommendations we have set out and discuss above, requires a multistakeholder approach, with the full involvement of the whole range of colleagues who collectively constitute what is currently referred to as the ‘modern healthcare ecosystem’. We refer here to clinicians of all types and grades of seniority, to health services managers; to professional and family carers; to social care professionals; to expert patients, patient advocacy organizations and patient charities; to healthcare chaplains; to politicians and healthcare policymakers; to health economists; to members of the pharmaceutical and healthcare technology industries, and to philosophers of medicine and healthcare.6 When all of these colleagues strive to understand each other, and actively collaborate, we come that much closer to making PCC an operational reality, and thus to delivering the common goal of superior clinical outcomes at lowered or contained clinical costs.6 Clinical practice operates on the basis of competency frameworks and codes of professional practice which direct education and training at both the undergraduate and postgraduate stages. Also, professional regulation and revalidation requirements, often onerous and bureaucratic, nevertheless drive changes in practice and the maintenance of standards. For this reason, the ESPCH advocates the revision of current ethical codes and regulatory mandates through the addition of clear guidance which embeds PCC as a necessity and imperative that is integral to clinical professionalism, and not a peripheral ideology or option that is solely associated with an individual style of professional practice. Such developments have the capacity to elevate clinical professionalism from what we have referred to as the ‘lower common denominator’ of legally acceptable, regulator-satisfying, basic technoscientific competence, to a ‘higher numerator’ of person-centred excellence. We assert that the former can only be understood as ‘second rate’ care, while the latter is, for us, incontrovertibly first rate in its nature, raising the bar from basic competence to high excellence.6, 12, 15, 16 Rather than representing an abstract concept, or a form of ‘virtue signalling’ with an associated moral posturing, PCC is in many ways a radical proposition within our current modern health services that have become reductively focussed on efficiency rather than quality, and when depersonalization/dehumanization and silo-isation have become the operational norm, to the direct detriment of patients. The understanding that PCC is not an optional extra but rather an essential, indeed vital, component of healthcare delivery, is at least partially based on acknowledgements of the consequences of its deficits within health services, and the increasing demands from patients for empathetic and compassionate care. In consequence, PCC is now becoming firmly embedded not only within what might be termed term the ‘clinical consciousness’, but also recognized by all those other members of the modern healthcare ecosystem that we describe above, as ‘a new way of thinking and doing in healthcare’ that encourages the pursuit of excellence in the care of patients, surely the cardinal characteristic of authentic professionalism.6, 12, 16 The progress of PCC to date has occurred through a relatively ‘quiet’ evolution, and not through a ‘shock and awe’ revolution, such as that which so characterized the inception and early development of EBM.3-5, 12, 13 In this way, PCC is establishing itself as the humanistic framework in which continuing technoscientific advances in medicine and healthcare can be delivered to patients with the aim of achieving excellence in both process and outcome. In this sense, PCC can accurately be described as ‘the new professionalism’ which returns to clinicians an ambition to treat patients as persons. Throughout this Editorial Introduction, we have considered modern understandings of PCC, its justifications, and the direction in which in our view methodological development and operational implementation should proceed. While the new Section is particularly enthusiastic to receive manuscripts for consideration focussing on the specific areas of study we have outlined, our focus has by no means been exhaustive and we welcome contributions on all aspects of PCC in all of the various publishing formats of the Journal. Authors should clearly mark their papers for the attention of the JECP Section on PCC, and any queries before submission may be discussed with the Section Editor [[email protected]]. The authors declare no conflict of interest. The authors have nothing to report.

Medical schools' curricula have expanded over the decades to incorporate important new medical breakthroughs and discoveries. Their current focus and overall structures remain, however, stubbornly captive of early 20th-century thinking, with changes having been undertaken in a piecemeal fashion. Indeed, since the notable Flexner reform in 1910, medical schools' study plans have suffered successive and typically always partial adjustments which have failed to keep up with scientific, technological and sociological change. This difficulty may be attributable to the well-known conservatism of medical schools, where updating study plans is a process that invariably encounters numerous barriers to change. These observations were afforded detailed attention some 15 years ago when de Oliveira wrote: 'it is now perfectly demonstrated that public medical schools have not been able to adapt their operation in depth and in due time to the new demands of teaching dictated by an explosive scientific and technological development'. Recent advances in communication and information technologies, as well as the introduction of new pedagogical techniques, have the potential to bring significant benefits to medical practice and healthcare systems, but these have not in the main become properly taught and utilized. The proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was initially regarded as highly speculative, yet systems approaches to biology and medicine are now beginning to provide experience of both health and disease at the molecular, cellular and organ levels. Medicine is a broad scientific field. In contrast to the 19th century, current medical 'sectarianism' is a positive by-product of rapid and gratifying medical progress, and the multiplicity of new models means that the lines of evidence legitimately bearing on practice and health policymaking are already highly diverse and likely to become ever more variegated over time. Put simply, most sound decisions, by definition, will be evidence-informed and not evidence-based, where divergence may be as informative as convergence. Here, the most enduring lesson of history is, perhaps, that clinical medicine is constantly rediscovering its humanistic core. Complexities create opportunities for innovation. In innovative environments, high-performing organizations are finding ways to create a culture that supports a diverse workforce preparing to deliver different models of care, with direct implications for excellence of patient experience and strong repercussions for medical education. The COVID-19 crisis saw major increases in the use of telemedicine, virtual office visits and other forms of online contact, and these are likely to increase considerably. This particular transformation will not be easy or comfortable to make. But reconfiguration of medical education seems inevitable, fuelled by online educational technology and the need to transform clinical training to more outpatient settings with promotion based on competency and person-centeredness, not simply time. As we prepare to enter 2024, this is an exciting time to be working in healthcare. We have more evidence than ever about how to provide high quality, person-centered care, and to keep patients safe. Shame on us if there is any hesitation about applying this knowledge to make the healthcare experience better for patients and providers. Embracing change and making continuous improvements are essential and urgent priorities for medicine and healthcare and, as we describe in the current article, will become more and more indispensably important in our rapidly changing world.

In this issue of the Journal, we begin the serialisation of a seminal new text which has significantly advanced current understandings of the conceptual basis of person-centered care (PCC) [1]. The volume, edited by Michael Loughlin and Andrew Miles, brings together 42 distinguished scholars, writing over the course of 28 chapters, divided into 6 definitive sections, spanning some 420 pages of text. Each of the chapters has distinct merit and, when studied collectively, the scale of their contribution to current thinking in the field becomes quickly apparent. The volume is scheduled for production towards the end of the current year and will be published by Aesculapius Medical Press (AMP), the publishing Imprint of the European Society for Person Centered Healthcare (ESPCH). A detailed overview of the volume has been provided by Loughlin, the lead co-editor of the book [2]. Loughlin’s paper [2] is a model of clarity, providing admirable insight into the content of the individual chapters, placing each of them within the context of the ongoing debate. As Loughlin [2] rightly notes, “the ideas and terminology of person-centred care ... have been part of health discourse for a very long time ... (and) ... arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity” (italicisation mine). He emphasises that “... it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply fine ideals or ethical add-ons to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice” (italicisations mine). These observations, indeed truisms, explain the rationale which underpinned the creation of the European Society for Person Centered Healthcare, and which continue to direct its mission.

a Professor of Person Centred Health and Social Care & Co-Director, European Institute for Person Centred Health and Social Care, University of West London; Honorary Professor of Person Centred Care, St, George’s University Hospital Campus, University of London & Senior Vice President/Secretary General, European Society for Person Centered Healthcare/Editor-in-Chief, European Journal for Person Centered Healthcare b President & Chairman of Council, European Society for Person Centered Healthcare; Chief Clinical Officer, Healthcare At Home/Deputy Chairman, Oxford Healthcare NHS Trust, England, UK; Chairman of the Editorial Board of the European Journal for Person Centered Healthcare & Visiting Senior Clinical Professor, European Institute for Person Centred Health and Social Care, University of West London, UK

In the opening paper of this, the most recent Complexity Forum of the Journal of Evaluation in Clinical Practice, Joachim Sturmberg and his colleagues1 argue that multimorbidity is the “… manifestation of interconnected physiological processes within an individual in his or her socio-cultural environment” (italicisation theirs). Sturmberg et al justify their thesis by reminding the reader that networks include genomic, metabolomic, proteomic, neuroendocrine, immune, and mitochondrial bioenergetic elements, as well as “social, environmental, and health care networks.” Stress systems—and other physiological mechanisms—create, they contend, feedback loops that “integrate and regulate internal networks within the individual.”1 The authors differentiate between those stresses that are easily distinguished as “minor,” in contradistinction to those more accurately described as “major.” Both of these, the authors assert, exhibit the potential to disturb internal and social networks, with each retaining the capacity to affect both internal and social networks and to precipitate a physiological instability that can at once range from improved resilience on the one hand to unhealthy adaptation and frank clinical disease on the other. So far, so good. But what other considerations are necessary? Sturmberg and his colleagues1 are clear that multimorbidity has to be understood as a “complex adaptive systems response” to bio-behavioural and socio-environmental networks. The authors argue that the design of integrative care delivery, an approach which is increasingly understood as vital in understanding underlying disease processes, in terms of their manifestation of a state of physiological dysregulation, is essential. This is, for Sturmberg et al, an essential “starting point” for shaping a care delivery approach that “more adequately addresses the underlying disease processes as the manifestation of a state of physiological dysregulation.”1 The authors assert that such a framework can “shape care delivery processes to meet the individual's care needs in the context of his or her underlying illness experience.” In this context, Sturmberg and associates1 are clear that “the future of multimorbidity management might become much more discerning by combining the balancing of physiological dysregulation with targeted personalized biotechnology interventions such as small molecule therapeutics targetting specific cellular components of the stress response, with community-embedded interventions that involve addressing psycho-social-cultural impediments that would aim to strengthen personal/social resilience and enhance social capital.”1 The authors' arguments are stimulating and warrant careful consideration. Accordingly, the Journal invited a range of distinguished colleagues to comment on Sturmberg et al's overall thesis and we publish the resulting analyses, sequentially, within the current Forum. We provide below a brief review of the core arguments of the individual articles in advance of considering the nature of their contribution to the development of person-centered health care approaches to the management of chronic multimorbid illness. In the first of the commentaries, Walker and Peterson2 note the existence of a great tradition of studying health and illness from a systems perspective, understanding that for clinicians, and people with illnesses, a great deal can be learned through the process of mapping the interface of different sectors to understand the nature of conditions. The authors present a sociological approach to the understanding of multimorbidity, in order to gain a fuller insight into the experience of illness of people living with multiple coexisting conditions within the “greater social system of health and illness.” They appeal to Parsons' notion of the “sick role,” so as to present a systems concept through which a proper understanding of the role of physicians can be assimilated, alongside an understanding of illness as a social phenomenon that extends beyond the purely personal. Walker and Peterson2 also utilize the concept of habitas and that of structure and indeed agency, here ensuring that the reader gains a real sense of morbidities as being in their nature social and economic phenomena and being of themselves a broader means of understanding current social systems. The commentators posit that one particular option for patient coping with multiple conditions is to change identity and they proceed to describe their meaning. We agree that the physician and patient encounter in dealing with the multimorbid condition is problematic, because, as they point out, it “forces attention on competence and responsibility in that continuing encounter.” Indeed, much work remains to be done on how the therapeutic encounter can be developed with reference to such mutual responsibility. The value of Walker and Peterson's contribution2 is, perhaps, the way in which the commentators apply the sociological approach to suggest an augmentation of what they view as a clinical microsystems approach taken by Sturmberg et al,1 and we look forward to further debate on how such “sociological supplementation” can enhance the development of more person-centered approaches to multimorbidity management that extend beyond the clinic itself. Following Walker and Peterson's paper,2 we come to the contribution by James Marcum.3 In his paper “Multimorbidity, P4 medicine and holism,” Marcum is concerned to examine Sturmberg et al's concept and understanding of holism as part of the authors' efforts to determine the causative factors for multimorbidity and their aim to respond clinically as a result. For Marcum,3 the authors' concept of multimorbidity, though far from reductive in any real sense, relies on an understanding of holism that sees the network's parts or subsystems as functionally independent of one another, but collectively responsible for the properties of the whole individual. In this sense, the authors' holism is general, in that it asserts that given components of the human individual are working together as an integrated unit to create and preserve homeokinetic stability. If this interpretation of Sturmberg et al's understanding is valid, which we think it is, then Marcum is correct in his description of the authors' holism as technoscientific, rather than humanistic or phenomenological, in its nature. Marcum compares and contrasts these two fundamentally differing understandings of holism, concluding that Sturmberg et al's P4 model remains distinctly biomedical in its conception. Accordingly, and with reference to the clinical case example given, Marcum3 asks “But does privileging the predictive and preventive aspects based on these [pathological] mechanisms provide the best possible care for this patient?” Marcum's view is that Sturmberg et al1 have stopped short of providing a definitive “yes” or “no” to this question and, despite the authors' own reference to person-centered care, Marcum feels, as do we, that Sturmberg et al1 have not convincingly demonstrated how they would integrate both internal and external factors relating to, and deriving from, the multimorbid state to achieve a properly holistic model for trial. The third commentary on Sturmberg et al1 in the current Forum has been contributed by Melis and his coworkers.4 For these colleagues, an understanding of multimorbidity as “the sum of individual diseases” risks ignoring the impact of their co-occurrence in the same individual. Melis and associates note that Sturmberg et al1 criticise the definition of multimorbidity as the co-occurrence of two or more diseases in the same person, but the commentators do not see this as the principal problematic in its use. Indeed, for them, a simple counting of the number of different diseases is not very informative, given its inability to provide sufficient clues regarding cause, prognosis, and consequences or the prediction of effect of clinical intervention. They conclude, then, that to move towards a properly person-centered care, there is a need to move beyond such counting and a need to widen the view of multimorbidity as a complex systems phenomenon even further, so that a more comprehensive understanding of multimorbidity for integrated care development and delivery can be achieved. For Melis and colleagues,4 the occurrence of multimorbidity may be causally related to a lack of health “both at the level of the individual and the level of the health care system and the community.” As they rightly point out, current health systems are simply not designed to cope with the problem of multimorbidity and have historically been designed to focus on single, largely acute diagnoses and not the chronic sequelae of multiple co-occurring conditions. Indeed, an urgent focus on the problem and consequences of multimorbidity “ … will need to be able to exist next to a single disease focus, because the fact that there are many persons with multiple diseases does not mean that there are no longer persons with single diseases.”4 We agree. We move next to the commentary by DeHaven.5 DeHaven concurs with the overall thesis presented by Sturmberg et al1 and is clear that the need to improve our understanding of disease processes to be able to intervene more effectively in their management has never been greater, due, perhaps in no small measure, to what DeHaven5 sees as Society's overreliance on the health care system for preventing and managing chronic disease. As he points out, existing health systems are ill equipped to respond to these requirements, not least because they have traditionally been designed to focus on individual organ system dysfunction and treatment, with the overall aim of resolving existing symptoms, with little historical emphasis on genetics, lifestyle, nutrition, exercise, the environment, and socioeconomic status as interacting determinants of predisposition and disease. The current global epidemic of multimorbid illness comes, to say the very least, as a challenge to conventional systems. DeHaven5 believes that persistent chronic disease prevalence can be addressed through community health science and he proceeds to discuss his rationale of how this approach is an alternative yet complementary approach to the more familiar perspectives of biomedical researchers. For DeHaver,5 the approach he presents has the advantage that it conducts research in the “real-world” setting where comorbidity and multimorbidity have become extremely common and where patients with multiple medical conditions are ineligible for entry into “conventional” clinical research trials. The ongoing focus of medical systems and research methodologies in the West continue, as DeHaver5 says, to be conceptualised with a reductionist philosophy and approach, which sees only the parts and not the whole. Yet all the evidence points to the fact that unless we urgently address the multiple causal factors of the multimorbid state, and develop the clinical methods with which to address them, we can reliably predict that the current problems we are experiencing will exacerbate and continue to spiral upwards in their severity. In the fifth commentary within the current Forum, we come to the contribution by Bircher and Hahn.6 For these commentators, it is certainly broadly justified to examine the problem of multimorbidity in the manner described by Sturmberg et al.1 However, the commentators find one question so far unanswered. Is it needed and possible, they ask, “to develop the whole diagnostic picture from molecular genetics to the person and [his/her] surroundings in each case?” In their paper, Bircher and Hahn6 explore the possibility of analysing patients in a more focussed manner through posing the questions “Is it possible to do the best for the patients, when applying a recently described model of health and disease, the Meikirch model? Can it identify the factors that are predominant in rendering a patient diseased, and can it help the patient to evolve further and to emerge into a better state of health?”6 Bircher and Hahn6 proceed to describe the Meikirch model to explain its applicability to the understanding and management of multimorbidity and to compare it with the network model advanced by Sturmberg et al.1 The Meikirch model consists of 5 components and 10 interactions, some or all of which may need to be explored in the context of the patient with multimorbid illness so that the overall process can generate a single, though inevitably complex, assessment of the condition of the given individual patient. Following this procedure, questions can be asked about what has happened, and what can be done, so that a range of options (by no means all of which will be strictly “medical”) become available for discussion with the patient and from which a selection can be made on the basis of priorities for early action. As Bircher and Hahn6 observe, the nature of the model is that it looks at health and the lack of it in the broadest sense and as part of a strong patient-physician relationship/partnership. As the commentators say, this renders a strictly nosological approach less discerning, though the viability of the model in practice will need to be tested through rigorous empirical and mixed methods research. For sure, the Meikirch model as described, possesses, we feel, the potential to help make greater clinical sense of the vision advanced by Sturmberg et al1 and thus to form the basis of a strongly person-centered model of care, an assertion to which we will return later before concluding. In the sixth commentary, David Aron examines Sturmberg and associates'1 thesis from the viewpoint of a clinical endocrinologist. Aron7 structures his analysis into four areas of comment and observation. Firstly, he is concerned to consider current conceptualizations of multimorbidity, moving subsequently to a review of the importance of networks to underlying human health and disease. From there, he proceeds to evaluate the evidence that supports the importance of network disruption in the underlying causal scheme of things, concluding with a discussion of what is “it” that “gets” diabetes. For Aron,7 the original conceptualizations of multimorbidity, which focussed on a simple enumeration of co-occurring diseases and the identification of their causal relationships, represented nothing more than a “unilevel approach to multimorbidity” that, with time (and following from appropriate attention being given to the effects of the interactions of multiple pathologies and the impact that these exert on the overall health, functioning, and quality of life of the patient, in addition to their effects on clinicians and health care systems themselves), has resulted in the development of a wide variety of measures of multimorbidity. This progress has enabled the addition of a vertical dimension, the value of which has been seen in its illustration that “for a given condition, there … (are) … issues at the cellular, organismal and community levels, to name just a few.”7 Aron proceeds to detail and discuss precisely what these “issues” are and how their insightful investigation has the potential to move the study of multimorbidity forward with speed. In concluding, and to remind readers of the importance of context and the risks of a narrow focus in clinical research and practice, Aron7 details a key extract from Francis Peabody's seminal paper, “The Care of the Patient,” published in the Journal of the American Medical Association in 1927,8, 9 following which Aron7 stresses to the reader that “While we hold onto our magnifying glasses, we should not forget to reach for the ‘minifying’ lens which allows one to see a more whole picture.” We agree wholeheartedly. In the seventh commentary, Rohleder10 commends Sturmberg et al1 for providing a new perspective on how central nervous system processes link a range of physiological networks to assist a more developed understanding of the mechanisms of human adaptation to both internal and external demands. Rohleder10 considers how the clinical case example considered by Sturmberg et al1 vividly illustrates the network of interconnected systems that is the subject of study by the authors. For Rohleder,10 it demonstrates, with excellence, the existence of a “network of networks,” providing insight into the aetiology of multimorbidity and thus a basis for modern clinical practices going forward. As he says, Sturmberg et al's1 assertions do indeed represent, collectively, “a powerful reminder that systems in the body are not acting in isolation but are interconnected and affect each other, directly and through the central nervous system, and that understanding these interactions of interconnected networks can explain currently not well understood issues of modern health care.”10 Rohleder reminds the reader that the extraordinary advances in biomedicine and health technology over the last 100 years or so have transformed the ability of medicine to deal with a range of issues and conditions that could simply not be easily dealt with in the past, and we believe that he is right to warn of the (increasing) dangers of superspecialization and to note, wisely, that superspecialization is likely to generate more problems than it will solve. Interestingly, Rohleder10 discusses how the multimorbidity framework presented by Sturmberg et al1 has additional value in providing a more holistic understanding of stress and its effects on the person, and he proceeds to detail in what way the framework contributes to an advanced understanding in this context, specifically how it augments the established allostatic load theory and provides a solid basis for newer modes of clinical research and biobehavioural understanding. The paper by Henry Heng,11 which closes this current Complexity Forum of the JECP, does not comment on Sturmberg et al's1 article in the manner of the seven such articles we have considered above, but surely represents an important contribution to taking forward the arguments within Sturmberg et al's1 article, which Heng considers shortly before concluding. Heng notes that the current era, which has seen the appearance of “big data-driven omics,” has proven a “double-edged sword” for molecular medicine. For sure, the initial optimism has, as he recognises, led to disappointment and confusion, as a function of inherent biological heterogeneity. Nevertheless, the recognition that diseases occur within the context of complex adaptive systems and the factor of cellular evolution, have been important outcomes of research to date and, as theories and models, combat the overenthusiasm for so-called precision medicine.11 For Heng,11 to reconcile the conflicts between the ambition for genetic precision and the correlative relationship between genotype and phenotype, a return to “basics” is required and he poses, in this context, five questions. What, he asks, is the common genetic and environmental basis of diseases? Can we cure the majority of non-Mendelian diseases on the basis of the precision of genetic information? What is the key limitation of current big data approaches to genomic medicine? What is the best way to integrate cellular evolution principles/management of common and complex diseases? Knowing that diseases (occur within) multilevel complex adaptive systems, should future strategies of medicine continue to focus on gene mutation and pathway-based molecular cures? Heng11 is clear that a new framework is necessary to explicate how genetic information is transferred during cellular evolution and how gene/genome/environmental interactions lead to diseases, and he proceeds to provide for the reader a detailed and important discourse, preceded by and organised under 5 specific foci of contention and discussion: (1) Genetic alteration is not just caused by genetic error, (2) Stress is both good and bad and can be linked to diverse molecular mechanisms, (3) Cellular evolution is hard to predict (especially during a long process or when under high-stress conditions that alter the genome), (4) Real-life complexity devalues the beauty of hopeful molecular simplicity, and (5) The common linkage among common diseases. As Heng11 says, many issues need to be discussed in the context of adaptive systems and, for us, the paper by Sturmberg and associates1 is a signal stimulus for such conversations. Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. How can we communicate the wisdom that these two Oslerian quotations vividly illustrate to a modern medicine overwhelmingly fixated with scientific progress in biomedicine and technology at the expense of the context of such progress—the person of the patient? How can we return to modern medicine and health care a preferential fixation with the destination of all biomedical and technological advance—the patient as a person who suffers? We will consider such questions here, within the confines of available space, with direct reference to the paper we publish by Sturmberg et al,1 a paper which has, as its primary focus, the “mechanics” of the origins and trajectory of the multimorbid state, but one which also expresses some high ideals that are urgently in need of translation into current clinical practice. Ziegelstein,12 writing in the Journal of the American Medical Association, reflects on the “almost unimaginable” possibilities for patient care that have the potential to be realized through advances in genomics, proteomics, pharmacogenomics, metabolomics, and epigenomics. He is clear, however, that an important element of discussion has been omitted from the ongoing discourse—that individuals are distinguished not only by their inherent biological variability, but also by their response to different disease manifestations. As Ziegelstein12 emphasises, individual people have individual personalities and varying resiliences/resources, which mediate, in significant measure, how they will respond and adapt to stress and illness and how they will respond to treatments, “so that the same disease can alter one individual's personal and family life completely and not affect that of another person much at all,” not forgetting, he points out, that “diseases do not just affect individuals; they affect their families and friends, and their communities.”12 Ziegelstein's12 assertions “dovetail” well, and not just tangentially, with the thesis of Sturmberg et al,1 in reminding the reader of the complex biological and “suprabiological” nature of the human individual and the inherent heterogeneity of the human “organism,” factors that are inescapable in any serious discussion of how we move scientific investigations of multimorbidity and its humanistic person-centered management, respectively, forward. What strikes us particularly in Ziegelstein's article is his conceptualization of the personome. He argues that the personome merits an entirely equal consideration as the genome, proteome, pharmacogenome, metabolome, and epigenome in their impact on the health, disease, well-being, and flourishing of the human person. Here, Ziegelstein12 is clear that the tools of precision medicine, while they have provided for us a much greater understanding of the cellular and molecular determinants of individual uniqueness, have nevertheless generated a set of specific challenges for physicians in training who find it increasingly difficult to get to know their patients as persons. For sure, junior clinicians (often with their seniors), now spend more time gazing into computer screens, replete with laboratory and imaging data, than looking into the depths of the suffering of the patient sitting in front of them—an incontrovertible prerequisite to considering how such suffering can be most humanly and therefore most comprehensively responded to. As Ziegelstein12 notes, the current medical curriculum entirely fails to militate against such an observation, so that it is easy to witness a failure within it to integrate, with the biological sciences, the psychological, social, cultural, behavioural, and economic factors that influence human health and disease. As a direct consequence, students easily gain the distinct impression that the psychosocial and societal issues encountered in clinical practice are somehow less important to patient care than the basic sciences. This is a matter of no small gravity and has direct implications for the ethics and professionalism of medicine and health care. Indeed, if such “modern understandings” are allowed to embed even further, they may prove extremely difficult, if not impossible, to de-inculcate from the collective clinical consciousness of the generation of clinicians that are to come, with all the implications this would have for patients. Sturmberg and colleagues1 appear primarily concerned to examine the biological basis of multimorbidity, drawing from James Marcum a description of their approach as one which is essentially technoscientific, rather than humanistic or phenomenological in its nature.3 We agree, though highlight what Sturmberg et al1 explicitly acknowledge as the way forward—an urgent need for clinicians “to partner with their patients to identify person-centred care that optimizes highly complex and sometimes conflicting information from multiple knowledge sources.” Indeed, there is no small urgency in creating the understanding within modern technoscientific medicine of the necessity for a shift away from scientistic reductionism towards a properly person-centric model through which the patient who suffers can be most appropriately assisted. Sturmberg et al1 are in agreement with such a contention and are clear that “optimal health outcomes – at the subjective and objective levels – are most likely to be achieved if biomedical and psychosocial interventions go hand in hand.” Indeed, the authors rightly argue that clinicians should seek to develop “person-centred holistic strategies aimed at restoring and maintaining physiological network homeokinesis,” so that a newer understanding of multimorbidity and the framework which can result from it, “can shape care delivery approaches to meet the individual's care needs in the context of his or her underlying illness experience” (italicisation theirs).1 These high ideals were the basis, in 2014, of the creation of the European Society for Person Centered Healthcare (ESPCH) and its official journal the European Journal for Person Centered Healthcare (EJPCH). The ESPCH is an international membership organisation which advocates a shift towards humanistic health care and which is currently engaged in the development of practical clinical models for the person-centered health care of a wide range of specific clinical conditions. The development of such models, which by their nature take full account of comorbidity and multimorbidity, is being accompanied by the production of associated clinical guidelines to assist clinicians and health care policymakers in ensuring that the ideal of person-centered health care becomes an operational reality. Additionally, and apart from its major conferences and symposia, the ESPCH has embarked on the organisation and delivery of specific training programmes and masterclasses, which are specifically designed to upskill clinicians in the use of condition-specific guidance and who, following such training, are then able to return to their institutions as teachers, mentors, and leaders. Through such work, which is usefully informed by important studies of multimorbidity such as those being undertaken by Sturmberg et al,1 the ESPCH has already been able to achieve demonstrable changes within the medical and health care culture, in the thinking of politicians and policymakers and in advising the health care industry in how best to make its own contribution to patient-centricity.13-20 As the ESPCH continues to grow rapidly, so does its expertise and the Society welcome enquiries from all colleagues with an interest in or responsibility for the development of person-centered health care. Further information may be obtained by writing to Professor Andrew Miles, Senior Vice President and Secretary General of the ESPCH, at the email address detailed below. In this overarching Editorial Overview to the latest Complexity Forum of the Journal of Evaluation in Clinical Practice, we provide for the reader a rapid overview of the constituent papers of the forum and an insight into how the ideals articulated by Sturmberg and his commentators are currently being translated into operational clinical practice and health care systems. The dramatic rise in long-term comorbid and multimorbid illness is the defining challenge of our current age. Not only does multimorbidity exert a major impact on human health and flourishing, accounting for approximately 70% of global mortality, but it retains the potential to bankrupt health care systems worldwide. The classic clinical strategy of “diagnose, treat, cure, and discharge” cannot apply to the multimorbid state, and different approaches have become urgently necessary as a result. The development of practical clinical models for the person-centered care of patients suffering from the effects of multimorbidity holds great promise for a far more sensitive and clinically effective approach to the management of multiple coexisting and interacting pathologies, and we commend Sturmberg and his associates for their visionary, energetic, and ongoing contribution to this field. We acknowledge the efforts of Dr Joachim Sturmberg and Dr Carmel Martin in their long-standing service and commitment as Co-chairmen of the Complexity Forum of the Journal of Evaluation in Clinical Practice and as Co-chairmen of the Special Interest Group on Complexity and Health of the European Society for Person Centered Healthcare. The authors declare no conflict of interest.

Clinical care in the home, utilized, administered and evaluated in terms of its clinical and economic outcomes within a population health management system, can help patients with long term conditions (LTCs) live healthier lives while reducing the costs of care across the system. This model, through the avoidance of emergency hospital admissions, reducing the need for hospitalisation to treat progressive illnesses and activating and empowering patients, supporting good primary care, ensuring continuity of care and providing on-going emotional, psychological and practical support, can greatly increase the overall significance and efficiency of clinical care in the home, delivered as part of a population health management delivery system. This article argues strongly for the innate superiority of home-based care approaches within the modern era, actively recommending such approaches for the good of individual patients and an integrity of the general clinical system. We present hard evidence for the durability of our approach in both clinical and economic terms and advance to the reader the merits thereof.

In the current issue, we publish a paper focussing on medication beliefs in rheumatology - specifically if and to what extent, rheumatologists’ beliefs on medication use align with those of their patients .

It is increasingly claimed that modern medicine has entered into crisis —a crisis of knowledge (uncertainty over what counts as “evidence” for decision-making and what does not), care (a deficit in sympathy, empathy, compassion, dignity, autonomy), patient safety (neglect, iatrogenic injury, malpractice, excess deaths), economic costs (which threaten to bankrupt health systems worldwide) and clinical and institutional governance (a failure of basic and advanced management, inspirational and transformational leadership). We believe such a contention to be essentially correct. In the current article, we ask how the delineated components of the crisis can be individually understood in order to allow them to be collectively addressed. We ask how a transition can be effected away from impersonal, decontextualized and fragmented services in the direction of newer models of service provision that are personalized, contextualized and integrated. How, we ask, can we improve healthcare outcomes while simultaneously containing or lowering their costs? In initial answer to such questions —which are of considerable political as well as clinical significance— we assert that a new approach has become necessary, particularly in the context of the current epidemic of multi-morbid and socially complex long term illness. This new approach, we argue, is represented by the development and application of the concepts and methods of person-centered healthcare (PCH), a philosophy and technique in the care of the sick that enables clinicians and health systems to re-introduce humanistic ideals into clinical practice alongside continuing scientific advance, thereby restoring to medicine the humanism it has lost in over a century of empiricism. But the delivery of a person-centered healthcare within health systems requires a person-centered education and training. In this article we consider, then, why person-centered teaching innovations in the undergraduate medical curriculum are necessary, as a first step, to achieving real progress in the integrity of modern undergraduate medical education. Without such innovations, we do not believe that suitable foundations for subsequent innovations in postgraduate training can be laid and, with them, a continuing professional education in PCH that spans entire medical careers. We first review the historical perspectives of relevance to our arguments and then advocate a radical re-think of what we believe to be the urgent imperatives for a modern medical undergraduate and postgraduate training.

Within our healthcare systems, avoidable error rates and medico-legal bills are soaring, care home and hospital scandals are frequent and patient-reported consternation and even frank distress with the inhuman way they are routinely ‘dealt with’ are all now so commonplace as to be almost normative. All of these things - and more - vividly illustrate that much is wrong within modern medicine and healthcare and that much, therefore, needs to be put right. If Society continues to tolerate this crisis of disregard and neglect and if it does not urgently take the time to consider why and how we have arrived at where we currently are - in order to take corrective actions - then we will have reached a very sad point in human history indeed.

In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’

We write this Editorial Introduction following the conclusion of the First Annual Conference and Awards Ceremony of the European Society for Person Centered Healthcare (ESPCH) hosted by Francisco de Vitoria University, Madrid, Spain, on 3 & 4 July 2014. The Conference proved an important event which successfully brought together a very wide range of distinguished speakers and delegates from across the length and breadth of Europe, the United States of America, Canada, Australia, New Zealand and elsewhere. Following the close of Day One of the Conference, and prior to the Conference Dinner, we were pleased to confer on particularly eminent colleagues, the Society's Platinum, Gold, Silver and Bronze Medals, the Presidential Medal and the Senior Vice Presidential Medal and, in addition, to award the Society's Essay Prize and Book Prize. A full Conference Report, with the usual obligatory photographs and a YouTube videolink to highlights of the proceedings, has been included within the first e-Bulletin of the European Society for Person Centered Healthcare, the Society's new bi-monthly and detailed Newsletter.