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

The movement for public participation in medical practice and its governance (‘participative medicine’) 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 ‘the medical model’), administrator-centred medicine (‘managed health-care’), 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 movement’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.