“One Size Fits All!” A Good Model for Medical Care??
– Greg Kutcher, MD, JGP Medical Journey Strategist
“The pace of acute care makes it difficult to consider more than a biomedical fix disarticulated from the patient’s prognosis or the longer-term consequences of treatment reconciliation.” Journal of Palliative Medicine
“The pace of acute care makes it difficult to consider more than a biomedical fix disarticulated from the patient’s prognosis or the longer-term consequences of treatment reconciliation.” Journal of Palliative Medicine
When you’re shopping for clothes, would you select something labeled “One size fits all”? Probably not. We all know instinctively that one size rarely works for everyone. We each have unique needs when it comes to fit, comfort, and style.
Now, that’s just clothing. So why does medical care often feel like a "one size fits all" approach—rigid and unable to adjust to our individual needs, preferences, or unique lived experiences?
A recent article in the Journal of Palliative Medicine, with the formidable title Systems Forces Leading to Feeding Tube Placement in Patients with Advanced Dementia: A Qualitative Exploration of Clinical Momentum, offers some insight into this question.
The study’s authors used semi-structured qualitative interviews with family members and practitioners to explore why hospitalized patients with advanced dementia often end up receiving feeding tubes, even when it may not be in their best interest.
Their findings reveal a system where well-intentioned, diligent clinicians focus narrowly on their own areas of expertise. In doing so, they often rely on protocols, algorithms, and evidence-based practices, leaving little room to consider the broader context of the patient’s overall health or long-term outcomes.
This creates a sense of clinical momentum where one action triggers another in a chain reaction, without anyone pausing to reconsider whether the original approach was actually the best fit for that individual patient. The authors describe this disconnect in acute care using the striking term "dislocation". Like a dislocated joint, it suggests how the patient's story is ripped away from the applied science we understand as medical care.
The dominant model in healthcare is what medical anthropologists call the "biomedical model". This model, while invaluable in many ways, can overshadow the human, social, and emotional aspects of care. Even the "biosocial model" still implies a duality, as if we can toggle between the medical and the personal, rather than integrating the two seamlessly.
At the Journey Guide Project, we embrace a more holistic model—one that weaves compassion, connection, and story stewardship into the fabric of care. It’s about starting with the patient’s story and ensuring that it’s an integral part of every decision made.
It’s easy to get caught up in the urgency and pressure of medical situations. The next time you find yourself, or your loved one, or your patient in such a moment, take a step back. Ask, “How does this evidence apply to me, or to my patient?” It’s a small but powerful way to ensure that care truly fits.
