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Editorials Christmas 2018

Rethinking medicine

BMJ 2018; 363 doi: (Published 13 December 2018) Cite this as: BMJ 2018;363:k4987
  1. Martin Marshall, vice chair Royal College of General Practitioners1,
  2. Jocelyn Cornwell, chief executive2,
  3. Alf Collins, clinical director3
  4. on behalf of the Rethinking Medicine Working Group
  1. 1Department of Primary Care and Population Health, UCL Medical School, London, UK
  2. 2Point of Care Foundation, London, UK
  3. 3Personalised Care Group, NHS England, London, UK
  1. Correspondence to: M Marshall martin.marshall{at}

There’s something going on out there

Modern medicine is one of humanity’s great achievements. It improves, prolongs, and saves lives by applying the biomedical and clinical sciences to the diagnosis and treatment of disease. Its strength lies in its clarity and focus, making it an easy model to explain, understand, and put into practice. People have found it powerful, beguiling, seductive even. It is not surprising that the medical model is proving so popular: it serves society well.

But there’s something going on out there. Increasing numbers of doctors and patients are questioning whether medicine has overstretched itself,1 whether it is always as effective as proponents claim, and whether there are instances when the side effects and unintended consequences outweigh the benefits. This critique is not new,23 but it has recently found a common voice in initiatives that transcend health systems and national borders, such as minimally disruptive medicine,4 high integrity care,5 and rethink health.6

In the United Kingdom unease with the medical model may be contributing to doctors’ low morale and to problems with …

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