[Noise in meaningful care; plea for a noisy and improvisational care practice].

The Dutch Healthcare Evaluation & Appropriate Use program aims to ensure that only proven effective care is provided. A protocol-based healthcare system is based on an ideal that leaves little room for an improvising healthcare practice with unique patient experiences. This essay articulates the contrast between a technological-rationalist approach to healthcare and the phenomena in healthcare that fall outside this framework. Phenomena that hardly fit within the political ideal of a healthy and productive society, such as suffering, misfortune, and death. Inspired by the philosopher of science Michel Serres, we refer to this as 'noise'. We argue that noise is not only an inconvenient interruption of effective care but, paradoxically, also its prerequisite. A well-functioning system is sensitive to the unprotocolled. In this way, noise undermines the problematic dichotomy between effective and ineffective. Medical practice must always address disruptive elements that do not fit within the discourse of proven effectiveness.