This model draws us away from a simplified, linear cause-and-effect definition of disease as being caused by a single intrusion into the person’s body that causes a specific disease. The reductionistic single cause, single disease, single cure (by reversing the action of the single-cause) model of healthcare can only explain about 20% of the conditions in any typical primary healthcare setting—yet it remains the dominant model for the mind-set of most physicians and health systems.
In stark contrast, 80% of people eventually develop chronic, complex conditions, often with multiple contributing factors across biology, psychology, sociology, the environment, that may improve with complex treatments yet are not curable. This, then, is the domain of chronic, complexity and primary healthcare—which only receives 5% of the overall healthcare resources in the United States yet faces the most complex challenges in healthcare. It appears we Americans favor paying for complicated chances for immediate fixes and cures, while under-paying for complex chances for improved quality and quantity of life.
And our methods for assessing the efficacy of treatments relies solely on the single-cause, single disease, single treatment model with the overreliance on Randomized Controlled Trials, which become highly challenging when causes are not certain and when treatments are highly complex—as is true with most chronic, complex conditions. The authors point out a combination of traditional, Newtonian natural science (causal) and a broader Meikirchian complexity science definition of health is necessary to advance our ability to improve the lives of those seeking out healthcare.
Complexity and Relationships
Complexity also draws our attention from the individuals toward the interactions and relationships between individuals—thus allowing us to recognize the centrality of the primary healthcare physician relationship with the broader healthcare team, patient and family. In single cause, single disease, single cure medicine it is only the individual’s biology that matters and is addressed. In the broader context of complexity, we must focus on the interactions and relationships across the many people involved in the care of the patient. Bircher and Hahn (2016, F1000Research) conclude their article with this moving description of critical nature of the physician-patient relationship to pursuing complexity-engaging health:
“For this purpose [of patient-derived, bottom-up insights and health] mutually trusting patient-physician interactions are critical for a successful future; the physician must believe in the patient’s abilities to evolve to a new state and must accompany and support him with loving wisdom in this endeavor.”
In this new complexity context, the physician shifts from one of being an objective scientific observer who is directing patients to consume treatments in a prescribed fashion to a being a coach or Sherpa, accompanying the patient on his or her adventure toward a healthier, more satisfying life. Yes, medications and other treatments may be necessary along the way—yet the focus is on that partnership relationship, bringing in many other experts and non-physician professionals to assure all aspects of the person’s health are addressed in a timely and effective fashion by the patient him or herself. Physicians must share this vital relationship with other professionals, providing the team care that is necessary to achieve health.
