River doctors: Learning from medicine to improve ecosystem management

•The framework adopted by medical practice offers considerable potential for improving ecosystem management.•Key principles applicable to both are: understanding system structure and function, identifying the mechanisms of ill health, carefully defining the goals of treatment, applying the best technology/methods, and relying on trained personnel.•The important steps in medical patient assessment, diagnosis, treatment, monitoring and prevention are also critical for improved ecosystem management.

Effective ecosystem management requires a robust methodology to analyse, remedy and avoid ecosystem damage. Here we propose that the overall conceptual framework and approaches developed over millennia in medical science and practice to diagnose, cure and prevent disease can provide an excellent template. Key principles to adopt include combining well-established assessment methods with new analytical techniques and restricting both diagnosis and treatment to qualified personnel at various levels of specialization, in addition to striving for a better mechanistic understanding of ecosystem structure and functioning, as well as identifying the proximate and ultimate causes of ecosystem impairment. In addition to applying these principles, ecosystem management would much benefit from systematically embracing how medical doctors approach and interview patients, diagnose health condition, select treatments, take follow-up measures, and prevent illness. Here we translate the overall conceptual framework from medicine into environmental terms and illustrate with examples from rivers how the systematic adoption of the individual steps proven and tested in medical practice can improve ecosystem management.

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