The question behind evidence-based care
There’s a tension that sits at the heart of modern healthcare.
We place enormous value on evidence, and rightly so. Evidence has transformed medicine and public health, helping us move beyond opinion towards approaches that consistently improve outcomes. It has shaped how medicine diagnoses, treats and prevents disease, and it continues to influence almost every aspect of healthcare.
Yet there is another question that we don’t ask often enough…
What happens when evidence developed for populations meets the complexity of an individual life?
That question has stayed with me because much of my professional life has involved caring for people rather than averages. Whether in Defence, emergency medicine, nursing or now precision health, the person in front of you has never arrived as a textbook example. They arrive with a history, a context and a biology that has been shaped by experiences you cannot always see.
Evidence answers one question. Practice asks another.
One of the unexpected privileges of working across several disciplines is that you begin noticing the same patterns appearing in different places.
The environments change.
The questions don’t.
During my years in the Air Force, I saw people complete the same training and perform in the same operational environment, yet recover very differently afterwards. In emergency medicine, patients with remarkably similar presentations could follow very different paths. Today, I see comparable patterns in women who have invested enormous time and effort into improving their health. They often arrive having followed sensible, evidence-informed advice with genuine commitment, yet their outcomes vary far more than they expected.
Those experiences haven’t made me question the value of evidence.
They’ve made me think more carefully about how evidence is applied.
Research helps us understand what is likely to benefit many people. Clinical reasoning asks an additional question.
Does this recommendation make sense for this particular person, at this particular point in time?
That is a different conversation altogether.
No one arrives as an average
Population research is one of the greatest strengths of modern healthcare. It allows us to identify patterns that would be impossible to recognise from individual experience alone. Without it, we would know far less about disease, prevention and recovery.
But populations are made up of individuals, and individuals bring far more to the conversation than a diagnosis or a symptom.
By the time someone reaches midlife, their biology reflects decades of adaptation. Hormonal changes, work demands, caregiving, interrupted recovery, environmental influences and accumulated stress all become part of the context in which every recommendation is received. Two people may appear remarkably similar on paper while beginning from very different biological starting points.
I sometimes wonder whether this is one reason capable people become discouraged.
When an intervention doesn’t produce the expected result, the assumption often becomes deeply personal. They conclude they must have lacked the discipline or persistence to see it through. Yet another explanation may deserve just as much consideration. The approach itself may not have reflected the biology receiving it.
Personalisation completes the picture
This is why I’ve become increasingly interested in personalisation.
Not because I believe evidence has failed us.
Quite the opposite.
Evidence gives us an essential foundation. Personalisation helps us decide how that foundation should be applied to the individual sitting in front of us.
For me, these ideas are complementary rather than competing. One helps us understand what generally works. The other helps us explore why the same recommendation may create very different outcomes once it meets a real person with a unique history of adaptation.
That way of thinking also changes the questions we ask.
Instead of searching immediately for the next protocol, we can begin by understanding the system receiving it. We become interested in patterns rather than isolated symptoms, in biological context rather than assumptions, and in the fit between the intervention and the individual.
This is one of the most important shifts occurring within healthcare today. Not a move away from evidence, but a move towards applying evidence with greater precision.
The question I’m becoming more interested in
The longer I work in this field, the less convinced I am that recovery is about finding the universally correct answer.
I’m becoming much more interested in understanding why different people respond differently to the same advice, and what those differences might teach us about health itself.
Perhaps that is where personalisation really begins.
Not with more complexity.
With greater relevance.
I’d be interested to hear your perspective.
How do we continue strengthening evidence-based care while becoming more responsive to the biology, history and lived experience of the individual in front of us?
