Intended for healthcare professionals

Rapid response to:

Observations The future of health care

Why innovation matters today

BMJ 2009; 339 doi: (Published 22 July 2009) Cite this as: BMJ 2009;339:b2970

Rapid Response:

Precise medicine:a chimera

Lord Darzi, in his article about innovations in healthcare[1] talks
about the need for medicine,
“to move dramatically from an intuitive level to an empirical (and
eventually precise) one”
This notion of precision is surely a chimera and is a dangerous myth.
Politicians are keen to adopt this myth because, if medical practice is
precise then it can be easily counted and hence costed, and it misleads
the public because it implies easy answers and a cure for everything. Yet
in the same edition of the BMJ, as the Lord Darzi article there are
several examples of the reality, where the messy imprecise, complex world
of medical practice is described. The obituary of Cecil Helman[2]
describes his understanding of the human condition and the need for people
to construct a narrative to understand and come to terms with their
illnesses. He recognized the value of helping people make sense of their
illness in their own terms, hence putting
“their life experience into a different, more empowering one.”
Nothing empirical or precise about that approach but that does not
diminish its value.

We have precise methods of diagnosis for swine flu yet this did not
help the patient when she returned from abroad with viral
symptoms[3].Culture, politics, assumptions and beliefs all conspired
against her so that she never received any precise answers.

We are precise when we diagnose breast cancer but is this necessarily
in the interests of the patient? Does the early diagnosis of cancer
actually help the patient?[4]

The artistry in medicine is about understanding the human condition.
It is about acknowledging the uncertainty of practice and it is about
educating doctors to be able to make difficult judgements which are not
always based on easy “precise” answers. This is not to denigrate Lord
Darzi’s plea for more innovation. He is correct in this but as a delegate
at the recent conference to which he alludes, there is more to innovation
than trying to find precise answers within a technological framework.
Education of our junior doctors must allow them to explore ideas and think
philosophically about what healthcare really means to our patients. Des
Brown (discussing screening)[5] sums it up well when he writes,
“Doctors are complicit in the theft of society’s most precious possession
of all: a sense of wellbeing”

Understanding that sense and being able to tailor diagnosis and
therapy to our patients is more than “intuition” but should continue to be
the bedrock of practice into the 21st century.

[1] Darzi A. The furture of healthcare. BMJ. 2009;339:b2790

[2] Rosenthal J, Singh S. Obituary: Cecil Helman. BMJ. 2009;339:b2409

[3] Mayor S. You can't have swine flu: Personal view. BMJ.

[4] Welch HG. Overdiagnosis and mammography screening. BMJ.

[5] Spence D. From the front line. BMJ. 2009;339:b2793

Competing interests:
None declared

Competing interests: No competing interests

26 July 2009
Penelope A L Gordon
Consultant radiologist and Director of Education
Portsmouth Hospitals NHS Trust, PO6 3LY