Reconsidering success and failure in medicine through patient-centred care

A family physician explores how different values shape perceptions of success in medicine, advocating for a broader understanding that aligns with what patients truly value.

Christine Marie Deeths, a family physician who teaches palliative medicine, turns a personal argument into a broader question about how medicine defines success and failure. In her account, a relative criticised her for taking her chronically ill daughter into ordinary childhood experiences, from holidays to trips by plane, while another family kept a transplanted child in near-total isolation to reduce infection risk. Deeths says both families were trying to do what was best, but were guided by different values: one prioritised safety and survival, the other prioritised a fuller life.

That tension is familiar in palliative care, where clinicians are often asked to help families choose between length of life and quality of life. A review in the journal BMC Palliative Care says ethical care depends on respecting patients’ autonomy and dignity, including the right to withhold or withdraw life-sustaining treatment. Another systematic review of specialist palliative care practice found that ethical dilemmas are routine, underscoring the need for ongoing discussion, teaching and support.

Deeths argues that medicine too often describes setbacks as patient failings, whether a person does not take medication as prescribed, misses follow-up visits or does not respond to treatment as hoped. She suggests that such language can obscure the real barriers people face: limited resources, treatment burden, poor health literacy or simply the mismatch between a person’s circumstances and the demands placed on them. In her telling, the issue is less whether patients are failing than whether the system is asking the impossible.

To make that point with trainees, she uses a classroom exercise in which students are given very different building materials and then told to build a tall tower in two minutes. The point is to show that failure can be engineered by design rather than earned by effort alone. Deeths uses the same idea to challenge clinicians to reconsider what counts as failure when a patient chooses hospice, declines another round of treatment, remains full code or dies despite maximal intervention.

Her own daughter, she writes, has spent long stretches in hospital, undergone major operations and lives with a port, but has also travelled widely, attended school and experienced much of the ordinary joy of childhood. Deeths says that, despite the risks, she does not see that as a failure. For her, and for the patients she now treats, the better measure is whether medicine helps people live and die in line with what they value most.