Person centered healthcare and clinical research: the necessity of an evolutionary hierarchy of knowing and doing

Loughlin, Michael ORCID: and Wyer, Peter (2020) Person centered healthcare and clinical research: the necessity of an evolutionary hierarchy of knowing and doing. European Journal of Person Centered Healthcare, 8 (2). pp. 235-250. ISSN 2052-5656

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Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients risks being ignored.
Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterise more or less developed thinking and judgement on the part of the particular practitioner.

Item Type: Article
Identifier: 10.5750/ejpch.v8i2.1847
Additional Information: This is the final published version of an article which appears in the European Journal of Person Centered Healthcare, published by Aesculapius Medical Press and The European Society for Person Centered Healthcare. This version of the article is made available with permission of the Secretary General of the European Society for Person Centered Healthcare and is available to view at the following link: (DOI link:
Keywords: Engagement, epistemic hierarchies, evidence, evidence-based medicine, judgement, knowledge, person-centered care, personhood, reasoning, science, wisdom
Subjects: Medicine and health > Person centered care
Related URLs:
Depositing User: Michael Loughlin
Date Deposited: 18 Aug 2020 21:04
Last Modified: 06 Feb 2024 16:04


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