How (highly unique) Mrs Jones can meet (highly scientific) precision medicine? An introduction to values-based practice

Abstract

There is a tension in contemporary clinical care between generalization, as required in the scientific process of evidence-based medicine, and personalization, as required for the autonomy and care's meaning of an always unique patient. We present here some of the key elements of values-based practice, a shared decision-making process that aims to reconcile these two major trends in clinical care. Values practice is rooted in pioneer work about values from ‘ordinary language’ analytic philosophy (the ‘Oxford School’). As such, it has developed in response to key insights from ways of thinking the world, highlighting the universality of values in care. Values-based practice is a partner to both evidence-based practice and ethics for supporting shared decision-making when complex and sometimes conflicting values are is in play. The story of Mrs Jones’ knee, an everyday situation of surgical care, and the Montgomery ruling, a famous legal case from the UK Supreme Court, show why it is so essential to incorporate the values of the individual patient within a model of shared decision-making. Values-based practice relies on learnable clinical skills allowing clinicians to take into account the actual values of every unique person involved in a unique situation. This is required if precision medicine is to deliver genuinely personalized medicine as the basis of truly person-centred clinical care.