Analysis Essay

How medicine has exploited rationality at the expense of humanity: an essay by Iona Heath

BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5705 (Published 01 November 2016) Cite this as: BMJ 2016;355:i5705
  1. Iona Heath, former general practitioner
  1. London, UK
  1. iona.heath22{at}yahoo.co.uk

Iona Heath argues for a rebalancing of the two sides in every clinical consultation, championing that for which evidence based medicine has no answers

In 1876, George Eliot wrote, “Attempts at description are stupid: who can all at once describe a human being? Even when he is presented to us we only begin that knowledge of his appearance which must be completed by innumerable impressions under differing circumstances. We recognise the alphabet; we are not sure of the language.”1

In just such a way, evidence based medicine tempts us to try to describe people in terms of data from biomedical science: these are not, and will never be, enough. Such evidence is essential but always insufficient for the care of patients. It gives us an alphabet—but, as clinicians, we remain unsure of the language.

Most clinicians are not scientists; they have a different responsibility—to attempt to relieve distress and suffering and, to this end, to enable sick people to benefit from biomedical science while protecting them from its harms.

Each patient has unique values, aspirations, and context. More fundamentally, history and experience alter how each body works through many mechanisms, and socioeconomic inequality and the directly consequent unequal distribution of hope and opportunity often play out in premature disease and death.

Clinicians must see and hear each patient in the fullness of his or her humanity in order to minimise fear, to locate hope (however limited), to explain symptoms and diagnoses in language that makes sense to the particular patient, to witness courage and endurance, and to accompany suffering.

No biomedical evidence helps with any of this, so a rift runs through every consultation. On one side, evidence has a huge part to play, assuming it is free of bias; on the other side is the substantive role for …

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