Intended for healthcare professionals

Observations Bad Medicine

Des Spence: Why #healthbeliefs should be top of all our communications

BMJ 2020; 368 doi: (Published 26 February 2020) Cite this as: BMJ 2020;368:m695
  1. Des Spence, general practitioner
  1. Glasgow
  1. destwo{at}

It was 1986—before the preferred pronoun, when # was an obscure wannabe on life’s keyboard, and when avocados were never crushed but were eaten unripe at Christmas, with prawns and Marie Rose sauce.

I reached for my near empty packet of Marlboro beside a mug full of cigarette ends. I struck a match, being careful not to torch my “big hair” laden with product, and twisted my earring anxiously, thinking how it didn’t suit me. I clasped my cigarette stained hands together and pressed them to my head, praying to God that the brachial plexus wouldn’t come up in my exam.

Then I raised my head and laughed. Had my late anatomy revision really come to this? My atheism had been usurped by my Christian conditioning. The thing is, beliefs defy reason. Many deeply scientific people believe in one of the many competing gods. And atheism certainly has no monopoly on truth: truth is mercury. But our beliefs blind us, and challenging them invariably leads to conflict. Best always to respect others’ beliefs.

Doctors are intelligent people—no, we truly are! Medicine is but a belief system too, rife with false deities, leaps of faith, learnt incantations, and physical rituals. I don’t believe in quite a lot of it: most clinical examination; primary prevention treatment of cholesterol; bisphosphonates; migraine treatments; and, of course, all foot and shoulder surgery. All just post-truth, fake scientific nonsense. (Getting angry?)

This model suggests that everyone has a set of health beliefs, passed down in families and from wider society too. Think of the families who endlessly attend clinics. The cultural elements of health beliefs are conditioned directly through the actions of a country’s medical profession: doctors attempting to extort as much money as possible through over-investigation, overtreatment, and needless surgery. Medicine’s core business plan is to make even well people think that they’re sick.

By our standards, North Americans often have aberrant medical beliefs (though normal to them). Antibiotics and scans at every consultation, annual blood tests, and pre-emptive cancer surgery. Doctors have fixed health beliefs too: even suggesting that homeopathy is an effective placebo turns both sides of the medical divide into frothing banshees. And health beliefs are ubiquitous, in every single consultation. Doctors frequently fail to understand patients’ health beliefs, dismissing those that are not congruent with their own. Predictably, this leads to dissatisfaction on all sides, and doctors are perceived as arrogant.

Thirty years on from my studies the fashions and habits have changed, but we still cram students’ heads full of irrelevant factual details while avoiding the more important concepts and ideas that make us better doctors. My health belief is this: in the coming decades imaging, laboratory testing, and diagnostic algorithms will usurp the profession’s position. Only those of us with high emotional intelligence will survive, and core to this is respecting patients’ differing health beliefs and agendas. But #imightbecompletelywrong, and #godmightexistalthoughthisseemshighlyunlikely.


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.