Alf Collins, a co-founder of the Rethinking Medicine project, is a doctor, commissioner, researcher and national policy adviser in person-centred care.

People come to see doctors with problems. They tell their story, the clinician examines them, clinches a diagnosis (perhaps after ordering a test or two) and then prescribes a fix. It’s that simple. Occasionally. 

Much more often, people come to see doctors with complex stories of dis-ease, or with multiple conditions, many with their roots in the social determinants of poor health. 

And many people (not just patients, it’s true of doctors as well) over-estimate the benefits of medicine and underestimate the harms, as well as not understanding the uncertainty inherent in all clinical practice.
Added to this, patients often tell us that they are not being treated with dignity and respect or as unique individuals. And increasingly, they are telling us that medical treatments come not just with side-effects but with additional burdens (such as attending check up appointments) that can become intolerable for those living with multiple conditions.
There is, then, a good case to rethink the medical model, but the truth is professionals have been questioning the model from many perspectives for decades. This might be through focussing on social determinants, on treating people with more compassion and taking a more personalised approach to care, on the over-diagnosis and over-treatment agenda or on multi-morbidity and the burden of treatment agenda.
These multiple perspectives provide a rich and fertile ground from which to build consensus and action for a significant rethink but I think we need to proceed with caution.

“There is a good case to rethink the medical model, but the truth is professionals have been questioning the model from many perspectives for decades.”

Medicine is one of humanity’s greatest achievements; it just has a tendency to over-reach itself. Many of the movements mentioned above, for instance the over-diagnosis agenda, the person-centred agenda and the burden of treatment agenda, have often been described as being in opposition to the medical model – or at least a counterbalance to it. This is clearly both wrong-headed and counter-productive.

Good medical care takes account of social determinants, multi-morbidity, over-diagnosis and over-treatment. Good care treats people with dignity and respect and personalises care by recognising that patients bring their own values, preferences and assets – as well as their needs – to consultations. And good care also means minimising the burden of treatment, especially for those with multiple conditions.
IT and artificial intelligence will never take the place of good medical care, but in order to pay attention to the various facets of 21st century medicine outlined above, clinicians will need to unburden themselves of one of their current responsibilities – to hold a lot of data in their heads – and hand that over to computers.

​They will then be able to focus on what really matters – doing the right thing with the individual patient sitting in front of them.

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