Personal Views

Papa, Nicole, and the guideline industry

BMJ 1998; 316 doi: (Published 30 May 1998) Cite this as: BMJ 1998;316:1681
  1. Paul Hodgkin, codirector
  1. Centre for Innovation in Primary Care, Sheffield

    In the television advertisement for Renault neither the suave Papa nor his sophisticated daughter, Nicole, are thinking much about cars. The advert does not mention guidelines, evidence, or outcomes, and fails to suggest any audit of the all important car buying cycle. Indeed cycles of any kind are the last thing on Nicole's mind and Papa is clearly not interested in setting standards against which to measure performance. If a rational approach changed behaviour then our commercial breaks would surely be a lot duller. The lesson from Papa and Nicole is that people are more likely to act when they feel good, flattered, tantalised, powerful, sexy, or proud than when they are flooded with facts.

    This is not to put down facts. But in motivational terms a good story is worth a dozen facts. Medicine after all is structured around the endless (hi)stories that patients bring, and “I had a patient who” is almost always more memorable than “I read a paper that.” We run on stories not facts, because this is how, over past millenniums, we made sense of our worlds. Today that need to derive meaning through story, myth, and metaphor is played out on ward rounds and in the surgery, in casualty departments and the ambulance, and in the detailed, intuitive, sense making way in …

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