If it doesn't work, stop it. Do something else! Academic Article uri icon


  • EDITOR—Many letters to the editor have followed each other in the BMJ debate on the extremely important theme of stopping doing what we usually do, when it does not work. This seemingly being the most difficult thing a physician can do! May we suggest that we expand the range of the physician's activities with other toolboxes than the biomedical, so that we can find something new to do, when what we usually do does not work? If the NNT (number needed to treat) of the best working drug or operation is say 5, 10 or even higher, rendering only a small fraction of our patients helped by our medical intervention? Remembering the old definition of insanity and its treatment: "to continue doing what we always have done, expecting new results", we on the other hand suggest that the physician should be open-minded to other kinds of treatment and perspectives on health and disease. In fact we actually want the modern physician to be multi-paradigmatic. All medical work is based on the intention of doing good, either improving the health, the quality of life or the ability of functioning – or a combination. Independently of the good intention coming from the physician, the medical work is always bound to some medical theory or a frame of interpretation. Hence the different paradigms1 -giving a number of different perceptions, hypothesis, diagnoses, actions and reactions. Just compare how we construct our consciousness in general and in our reality.2,3 The process of healing is – as life itself -often fairly complicated. The course of the disease, the healing process, personal development, learning and coping in connection with a disease is highly individual.

publication date

  • April 26, 2004