On the origin of variationBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5071 (Published 02 December 2009) Cite this as: BMJ 2009;339:b5071
All rapid responses
In the article as well as in the various responses, evidence is
adduced from individual scenarios or examples. This is not wrong in
itself and indeed Hawkes comments on the desirable variation of
individualised care for a pregnant mother. However, this might better be
described as customisation. The guideline or standard is consciously
adapted (varied) to the individual. In the same manner, those that wish
to, can order their new car in any colour they desire. The majority of us
however, chose from the limited palette that is available in the
But much of what happens in medicine is not a conscious variation or
Medics have a long long history of ignoring the advice (actively or
passively) and describing this as some form of intentional variation.
Advocates of non techical innovation in healthcare have over the years
been shunned, ostracised or ridiculed. We pillory those that highlight
the defective nature of our medical care, whilst insisting on
standardisation of all the machines and technology that supports us in
delivering that care. Maybe defibrillators should have a variable dial
setting and we can see what dose of volts we might like to deliver today?
Equally, we dress up this variation as innovation. If it truely is
innovation, why don't we call it research. And if it is research, should
not the patient be informed.
Or is is just that we can get away with our "variations" until someone
Competing interests: No competing interests