Feature Christmas 2017: Time and Place

Brutalist medicine: a reflection on the architecture of healthcare

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5676 (Published 11 December 2017) Cite this as: BMJ 2017;359:j5676
  1. Benjamin Mazer, resident in pathology
  1. Yale-New Haven Hospital and Yale School of Medicine, New Haven, CT, USA

Will the fashion for evidence based medicine and technological solutions come to be viewed the same way as brutalist architecture, asks Benjamin Mazer

benjamin.mazer@yale.edu

The current fashion in medicine is to label things as either “evidence based” or “not evidence based.” We use these labels to describe treatments, diagnostic tests, public health policies, and even people. This dichotomous worldview, however, fails to capture the nuance of the medical landscape. The use of evidence to drive medical decision making should be lauded, but there will always be more to providing proper healthcare than reading statistics in a journal or following clinical algorithms. The shorthand we use to convey this reality is “the art of medicine.” I think a better analogy would be “the architecture of medicine.” After all, proper medical care has a structure built around a clear purpose: to improve the health of the patient. It is engineering with flair.

At the same time, an unyielding focus on utility and regulatory compliance is the cause of many of contemporary medicine’s vivid eyesores: the proliferation of rigid yet contradictory clinical guidelines; blunt point-of-care applications; and electronic medical record systems usually described as a hurdle rather than as a tool. Each of these engineering innovations promised medicine a new evidence based foundation but have instead been introduced without considering the longstanding traditions our community holds dear. This contradiction in today’s medical practice, its simultaneous focus and myopia, is reminiscent of the brutalist architecture movement.

Brutalism was a fashionable global architectural phenomenon that peaked in the 1960s and 70s, but the avant-garde structures were then rapidly rejected as ugly, socialist nightmares. Brutalism valued unabashed …

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