The Complexity of 21st Century Health Care

The Complexity of 21st Century Health Care

Jeremy Fish, M.D. and William Bergquist, Ph.D.

Everything is interwoven, and the web is holy; none of its parts are unconnected. They are composed harmoniously, and together they compose the world. One world, made up of all things. One divinity, present in them all.  Marcus Aurelius, Meditations

COVID-19 may be the single most impactful disruptive force in contemporary healthcare history—yet it does not disrupt alone. It is fully interwoven in a complex web of health care perspectives and practices–and is fully connected to the many other societal challenges facing us in the mid-21st Century.

As Marcus Aurelius noted many centuries ago, everything is interwoven and COVID provides some of the most vivid thread for the tapestry being woven in contemporary life. There is much we can learn from our COVID experiences that would benefit not only our understanding of 21st Century health care systems, but also more generally the nature and dynamics of all complex systems in which we live and work.

Preface: Enter COVID-19/What Do We Do?

A challenging situation is easily portrayed regarding COVID. It is surging through the American health care system – which is one of the largest, most complex human systems on earth. As a powerful force of nature, COVID is disrupting a long tradition of system inertia in the United States. It is still not clear who will win. The American health care system has successfully resisted most bold new initiatives and external pressure from outside agencies—triumphantly overcoming regulators coming from the halls of justice and power.

What other industry that consumes trillions of dollars primarily settles its court cases for decades without trials? What other industry piles on thousands of new regulations, yet seems to experience little visible change in overall operations? There are likely no other industries that create more waste than the budgets of most nations annually with little progress in reducing those wastes despite decades of effort. The closest human-built innovation to disrupt healthcare in the past twenty years was the 2010 Affordable Care Act—which continues to struggle to reach more universal coverage at more affordable prices. It struggles due to enormous political push-back and inertia–despite rising public support and enormous financial investments.


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About the Author

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Jeremy FishDr. Jeremy Fish, MD is a Family Medicine Specialist practicing in the State of California with over 31 years of experience in the medical field. Dr. Fish serves as program director and co-founder of the John Muir Family Medicine Residency Program. He was the California Association of Family Physician’s 2020 Family Physician of the Year. Jeremy Fish received this recognition in part because he “models the way for family medicine residents by providing exceptional care in a state-of-the-art, team-based care model he designed and shepherded through accreditation”. The CAFP citation continues. Dr. Fish “embodies all that the award recognizes: a family physician who presents the finest characteristics of family medicine and is directly and effectively involved in public service and activities that enhance the quality of life for patients and communities in California. Despite having many years of clinical experience under his belt, Jeremy Fish remains a humble practitioner with healthy curiosity and an enjoyment of learning which he loves to share with both medical students and residents. As a physician leader, Jeremy is willing to be on the cutting edge and traverse difficult, yet rewarding, pathways to advance Family Medicine.”

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