https://orcid.org/0000-0002-0186-1166
Figures & data
Table 1. IMS as overarching approach to medical action
Figure 1. Maximizing therapeutic success requires physicians and patients to cooperate.
Notes: According to presence or absence of cooperation, IMS identifies four patterns of physician–patient interaction that impact therapeutic success. The (1) collaboration-centered type of interaction may gain optimal results of therapy. The (2) disease-centered type may dominate in acute emergencies with unconscious patients, and no possibility of patient–physician communication. In (3) patient-dominated interaction, only physicians can practice cooperation, which may be the case when physicians adhere to their duty-driven action design while patients maximize their own utilities by concealing some facts about their disease or behavior. In (4) physician-dominated interaction, only patients cooperate, which may happen in patients who prefer to subject their own judgment to physicians’ authority.
Figure 2. IMS basic design of cultural and moral diversity.
Notes: Only physicians face direct restrictions of their cultural and moral diversity. Conversely, patients face restrictions indirectly because they deal with physicians with limited diversity. In sum, IMS is an example for a strategy design that balances integration of cultural and moral diversity with insistence on essential cultural and moral principles.
Figure 3. The aims of biomedical therapy are only few, they are uniform, and well defined.
Figure 4. The nomenclature of medical rationality, strategy, and ethics.
Notes: POP identifies primacy of the patient; CI-2, Kant’s second formulation of the categorical imperative; TOI, target of intervention; and GOT, goal of therapy.
Table 2. Three-dimensional views on human affairs in narration, psychology, and social sciences
Table 3. Matching concepts of IMS with the real world’s three dimensions
Table 4. Examples for failures of therapy per dimension of success
Figure 5. IMS seeks therapeutic success in the following three dimensions: (1) biology, (2) sociology, and (3) psychology.
Notes: IMS addresses these three dimensions of success (1) as efficiency by achieving biological goals such as medication that normalizes blood pressure or surgery that completely eradicates cancer (“doing things right”), (2) as effectiveness by achieving social goals such as satisfying guidelines, patients’ purposes, and ethical demands (“doing the right thing” (Drucker, Citation1963)), and (3) as motivation by achieving psychological goals such as emotional support and identification of patients with therapy. IMS addresses (1) as technical dimension, (2) as normative dimension, and (3) as emotional dimension of success. All three dimensions are conflicting, where the target of intervention (TOI) may suffice all three demands equally well (TOI-1), or where TOI may be a compromise, where one dimension (psychology, for example) is not integrated (TOI-2).
Figure 6. I-SWOT matrix describes four principle types of strategic options, which have to be discussed with patients to identify an IMS of treatment (for detailed example, see von Kodolitsch et al., Citationin press).
Figure 7. Patient–doctors’ dialog for establishing a plan of treatment: IMS identifies medical rationality as physicians’ firm standpoint.
Notes: Physicians act as agents of medical rationality, where they inform patients about their pathologic condition including options of treatment, and negotiate patients’ objectives, and motivate patients to support therapy. Therefore, dialog is central to set up a plan of treatment that has the potential to maximize success.
