Appliquer la culture palliative au champ des maladies chroniques : le concept de médecine exhaustive

Regularly, calls for a new paradigm in health care are launched. We must think up a global, exhaustive and patient-centered medicine inspired by palliative culture and arte povera: “what we do is more important than who does”. The need for a shift is supported by the general trend of home return, saturation of hospital facilities and loneliness and frailty induced by chronic diseases. The patient remains the centerpiece of care. Patient's needs must be truly looked with empathy and technique: each story is unique and asks more than a normative answer. An in-deep understanding of dynamic and changing nature of the patient's needs must be undertaken and must satisfy the required composition of care and related services components, the patient's needs and costs. Exhaustive medicine is built on three pillars: generalist practitioner, nurse and informal caregivers strengthened by other referrers. Recognizing the need and the possibilities of cooperation and multidimensional interactions should lead to a network visualized as a controlled and cooperative organization based on respect, trust and shared decision making. Communication is the matter and the way to lead new social connection in the convoy of care. Exhaustive medicine is not a care system for providers but aspires to establish a system of values, to develop a new way to practice medicine for frail people. Exhaustive medicine is a network based on palliative culture, more receptive and comprehensive approach, shared decision, multiprofessional and subsidiary acting.