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Guillermou's avatar

Thank you for this reflection. Agonistic governance has a particularly relevant application in medicine: science advances through debate, reasoned disagreement, and the revision of ideas—not by suppressing discrepancies in favor of an institutional consensus.

The problem arises when bureaucracy, hierarchies, and organizational fragmentation turn protocols into ends in themselves. Procedures, reports, and layers of authorization multiply, while accountability for outcomes becomes diluted. Coordination between specialties, hospitals, researchers, and administrative bodies suffers, and the patient risks being sidelined in favor of the system’s own needs.

Evidence-based medicine should not become a rigid application of clinical guidelines; rather, it should integrate the best available research, professional expertise, and the individual circumstances of each patient. Protocols are necessary, but they must be open to revision; questioning them with scientific arguments should help improve practice, not lead to one’s dismissal or disqualification.

This transformation also demands a holistic view of illness and broader health education. Health does not depend solely on an organ, a molecular alteration, or a pharmacological treatment, but rather on the interaction between biological, psychological, social, environmental, and behavioral factors. Therefore, the training of professionals should include critical knowledge of nutrition, physical activity, sleep, stress, and the social determinants of health, as well as rigorous education in integrative and complementary medicine. It is not about equating all interventions or replacing effective treatments with alternatives lacking evidence, but about evaluating each practice with scientific criteria, distinguishing proven benefits from hypotheses and risks, and offering patients transparent information that fosters shared decision-making. Integration does not mean accepting everything, but rather investigating, evaluating, and selecting what truly adds value.

Effective healthcare governance does not eliminate disagreement—it transforms it into learning. When an institution prioritizes the defense of its own procedures over the correction of its errors, it ceases to serve medicine and begins to use medicine for its own ends. This article examines how forms, management diagrams, and bureaucratic mechanisms influence healthcare decisions—at times obscuring where those decisions are actually made and who is held accountable for them. https://www.tandfonline.com/doi/full/10.1080/13648470.2023.2242280

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