title: Change remains--paradigm shifts in modern surgery.
abstract: This article aims to describe underlying principles of paradigm shifts in clinical medicine by means of analysis of typical examples. Retrospectively, profound shifts of ruling paradigms can be shown in diverse fields such as outcome research, in the redefining of patients' and doctor's autonomies, in the challenges presented by consumer medicine and the free market economy. This has provoked controversy between doctors, patients and the community. The judgement on whether recent shifts in paradigms in medicine have improved the health care delivered today is by no means uncontroversial. Aiming to demonstrate how shifts of paradigms in medicine occur and what consequences can result from such shifts we reflect on the works of Thomas S. Kuhn, the eminent philosopher of science. An analysis of his theories lends important insight into the observed shifts in paradigms.
authors.affiliation: Department of General, Visceral, and Vascular Surgery, University of the Saarland, D-66421 Homburg/Saar, Germany. stefan.scheingraber@uniklinik-saarland.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Scheingraber
authors.forename: Ben
authors.initials: B
authors.lastname: O'Brien
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
mesh_terms: D004465:Economic Competition; D004992:Ethics, Medical; D013502:General Surgery / Q000639:trends*; D006801:Humans; D008962:Models, Theoretical; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D017009:Professional Autonomy; D011788:Quality of Life