Patient-Centered Measurement : Ethics, Epistemology, and Dialogue in Contemporary Medicine

Patients often are asked to fill out questionnaires before or after going to the doctor''s office or hospital. What is the point of these questionnaires? Why do the questions often seem irrelevant? Does it matter if patients fill them out or ignore them? This book addresses these questions while also providing historical context about how these questionnaires became so popular. These questionnaires, which philosopher Leah M. McClimans calls ''Patient-Centered Measures'' have a fascinating history that combines the contemporary emphasis in medical ethics on patient-centered care with the contemporary preoccupation with evidence-based medicine (the idea that medical decisions should be based on empirical evidence). Patient-centered measures sit between these two concerns and thus serve as an excellent example of a medical technology for the twenty-first century.

Contemporary medicine is Janus-faced. Evidence-based medicine is one face, emphasizing evidence, statistics, and method. Patient-centered care is the other, prioritizing patient experiences, judgement, and values. Government agencies, policy makers, major insurers and clinicians have sought ways to bring these approaches together, and the questionnaires that patients must fill out at the doctor''s office or hospital are its most common manifestation. Leah M. McClimans examines one such integrative approach, patient-centered measurement. Patient-centered measurement is the idea that patient perspectives on, for instance, physical functioning or quality of life, should play an evidentiary role in determining how effective a drug is taken to be, the degree to which a hospital provides good quality care or whether a particular intervention should be funded by an insurer. Patient-centered measurement treats patient perspectives on par with more traditional metrics such as mortality, morbidity, and safety. But how can measurement, which relies on standardization, represent patient perspectives, which, if not idiosyncratic, are at least various and changeable? Leah M. McClimans investigates the history and philosophy of patient-centered measurement, examining the use and role of patient questionnaires, and explores how patient-centered measurement sits within the contemporary preoccupation with evidence-based medicine.