Observations Reality Check

Reasons to be hopeful: streams of renewal in healthcare

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6042 (Published 12 September 2012) Cite this as: BMJ 2012;345:e6042
  1. Ray Moynihan, author and senior research fellow, Bond University, Australia
  1. RayMoynihan{at}bond.edu.au

Ten ideas that may produce a radical but coherent vision of future healthcare

Perhaps it’s simply because sweet spring and blue skies have returned to my home on the Australian coast, but it feels like a good time to celebrate some of what’s hopeful amid the constant chaos, change, and controversy that is contemporary healthcare.

The iconoclastic former BMJ editor Richard Smith has mused that medicine might need to feel utterly defeated for it to undergo much needed radical renewal.1 Whether or not defeat is imminent, a culture shift is being debated,2 and renewal is inevitable. The current medical-industrial paradigm—fragmented, technocratic, mechanistic, inhuman, and imperial—is neither healthy nor sustainable. While there’s much that is hopeful in debates about clinical medicine, public health, and beyond, I’d like to identify 10 streams of change that may ultimately coalesce to form a coherent vision of radical renewal.

Evidence informed approach

The evidence informed approach has helped provide a reality check to an overconfident medical establishment, identifying limits to effectiveness, sometimes trivial benefits, and often uncertain harms. It’s also helped sensitise policy makers and the public …

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