BACKGROUND The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness. METHODS Philosophical analysis of background assumptions of the current paradigmatic model. RESULTS While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency, to supplement the narrative of "the patient". This narrative is conceptually linked to the developing philosophy of person-centred care. CONCLUSIONS If patients are seen also as "agents" this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients' motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from "treating" and "battling" diseases and their purported "mechanisms" to understanding complex contributing factors and their interplay.

中文翻译：

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患者和代理商-或我们为什么需要不同的叙述：哲学分析。

背景技术药物在患者治疗中的成功带来了新的挑战。越来越多的人生活在功能性，慢性或多因素疾病中，这导致人们需要对健康和疾病的因果决定因素进行更复杂的分析。方法对当前范例模型的背景假设进行哲学分析。结果尽管这些因素不需要进行根本的范式转换，但它们确实使我们有理由发展一种新的叙述方式，以增加构成我们对医疗保健思想的现有叙述方式。在本文中，我们认为，对生活方式和共同决策的更多关注需要代理的新叙事，以补充“患者”的叙事。这种叙述在概念上与以人为本的护理的发展哲学联系在一起。结论如果患者也被视为“代理人”，这将导致实际决策的重大转变：这种叙述的发展和采用将帮助从业者与患者一起工作，以达到他们的共同利益，利用患者的动力，将重点从治疗转移到其他方面。预防和预防不必要的和有害的治疗，这些治疗可能源于我们对患者叙事的关注。它还将有助于将研究工作从概念上和经验上从“治疗”和“对抗”疾病及其所谓的“机制”转变为理解复杂的影响因素及其相互作用。这种叙述的发展和采用将帮助从业者与患者共同受益，利用患者的动力，将重点从治疗转移到预防，并防止不必要的和有害的治疗可能源于我们对患者叙述的关注。它还将有助于将研究工作从概念上和经验上从“治疗”和“对抗”疾病及其所谓的“机制”转变为理解复杂的影响因素及其相互作用。这种叙述的发展和采用将帮助从业者与患者共同受益，利用患者的动力，将重点从治疗转移到预防，并防止不必要的和有害的治疗可能源于我们对患者叙述的关注。它还将有助于将研究工作从概念上和经验上从“治疗”和“对抗”疾病及其所谓的“机制”转变为理解复杂的影响因素及其相互作用。