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Securing Health-Effective Medicine in Practice: A Critical Perspective on User-Driven Healthcare

The movement for public participation in medical practice and its governance (â€˜participative medicineâ€™) lacks an understanding of the historical and theoretical contexts within which it has emerged. This paper discusses the problems with physician-centred medicine (previously called â€˜the medical modelâ€™), administrator-centred medicine (â€˜managed health-careâ€™), patient-centred medicine, and participative medicine. The concept of health-effectiveness of medical services is emphasised as fundamental in an applied, critical theory of medical practice that equates health-effectiveness with pro-social medical services. The critical theory provides a framework for understanding the movementâ€™s purpose, its misuse by consumerist methods, and the problems when medicine is delivered by pro-market or provider-centred systems, as shown most notably in the Bristol Royal Infirmary Inquiry by the British government. The paper outlines the Tuke Institute model of health-effective services, secured by participative medical practice and its governance and integrated with translational science. Together, the Tuke Institute model and the critical theory provide a scientific framework by which to determine the health-effectiveness of different models of practice through properly scientific research, indicating the necessity of studying models of practice as complex interventions.