Unpacking the rhetoric of personalisation

14 July 2025 to 25 July 2025 is PHG Foundation’s personalised health fortnight. Follow and share the campaign on LinkedIn

Taking a personal approach is generally seen as a good thing in most contexts, and healthcare is no exception. Each of us, after all, comes with a unique biology and range of exposures that set the course of illness, as well as personal values and preferences which we hope to find reflected in the care we receive. The idea that our health is personal goes almost without saying.

This idea drives personalised approaches to health. But what does it take to personalise a health system to meet individual health needs? Two co-existing models have come to dominate responses to this challenge. One – commonly referred to as ‘personalised medicine’ – focuses on the importance of individual biology, turning to genomics in particular to tailor or target healthcare interventions more precisely. The other – ‘personalised care’ – caters to patient autonomy and seeks to promote this through everyday human interactions in healthcare. These approaches are not mutually exclusive, but they do serve two distinct purposes. 

Personalised medicine and personalised care: diving deeper into their differences

Personalised medicine embraces the use of technologies to improve the precision of interventions (in fact, some people prefer the term ‘precision medicine’, partly because this downplays expectations that medicine can be fully personalised to individuals). The appeal of precision is that it ought to improve the ratio of effective interventions compared with harmful or wasteful interventions. Pharmacogenomics – through which individual genomic information is factored into prescribing decisions (as we explored in a previous post in this series) – is the flagship approach in this regard. 

Incorporating genomic information helps to guide the decision-making of clinicians and patients by providing medical justification for a particular course of action – whether to prescribe a medicine, and in what quantity, or not as the case may be. The fact that the decision may be partly guided by the patient’s DNA does not necessarily limit their autonomy, but it does shape the choices that are available to them.

For the purpose of prescribing medicines, this is unlikely to cause concern because the outcomes – either taking more effective medication, or avoiding ineffective or harmful medication –  are clearly aligned with patients’ interests. But in other scenarios, the virtues of personalised medicine and personalised care may be in competition with one another and present trade-offs which are not as easily resolved.

Where personalisation meets prevention

These trade-offs are possibly most clear around access to services. ‘Personalised prevention’ borrows from the technology-enabled precision in personalised medicine and applies this to identify and ideally mitigate risk of disease in individuals. It features in the NHS’ 10 Year Plan for England as an ambition to use genomic and other risk information to encourage healthy living and detect disease at an earlier stage, partly via the NHS App. 

This approach could help individuals to keep healthy outside the health system by equipping them with personalised information and lifestyle interventions. It also enables the health system to personalise its approaches to population health management by using the available data to determine who may benefit from access to which services. The flip side of this is that data can be relied on more heavily to inform who has access to these services, thus potentially limiting the extent to which individual patients can exercise autonomy at the point of access to services. 

This doesn’t necessarily mean that personalised prevention isn’t a good idea. It may be an effective way of allocating finite resources to those who most need them. It can also be in an individual patient’s interests when it avoids interventions that are unnecessary and carry their own risk of harm. But it is important to be clear that personalisation does not guarantee health services will cater to the needs of individual patients as they perceive them, as can sometimes be implied.

Rammya Matthew, a GP and Medical Director in north London, recently wrote in the BMJ to caution against trends towards the provision of digital and automated information as a means to alleviate pressure on primary care, describing this as a form of ‘quiet exclusion [which] reflects a system more focused on managing demand and meeting targets than on improving care.’ This reflects a concern sometimes raised in relation to personalised approaches too, namely that it can shift the locus of responsibility onto the person who is seeking care. Is it easier to claim the solution is personal, if the problem is framed as personal to begin with?

Where do we go from here?

Personalised medicine and personalised care are associated with unique virtues. These approaches are sometimes compatible and capable of being pursued in tandem. At other times, they present an uncomfortable trade-off: namely, that implementing personalised health at the population level can prioritise data about individuals over the understanding and insight gained by patients and healthcare professionals during their encounters with one another. When the benefits of personalised medicine and personalised care are automatically conflated – evident in the 10 Year Plan’s core message to ‘put power in patients’ hands’ partly through a shift towards technology-driven precision – there is a risk such trade-offs go unacknowledged. 

Where does this leave personalised health? At the heart of this is a question about whether healthcare should start with biology and arrive at the person, or vice versa. One solution is to ask in which circumstances does understanding an individual’s biology and exposures improve the healthcare they receive, and in which is it more important to begin from understanding and interacting with what matters to patients. We also need to interrogate the language of personalisation and the purposes to which it is being put to use more carefully – and not assume the health system and individuals will benefit all at once without directly engaging with the advantages and disadvantages of personalisation. 

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