Why family medicine is more complex than you think…

On October 31, 2018, Dr. Joachim Sturmberg gave a talk about complexity theory and family medicine at the Lown Institute. Here are some key takeaways and a video recording of the talk, in case you missed it!

Dr. Sturmberg is associate professor of General Practice at Newcastle University in Australia and the Foundation President of the International Society for Systems and Complexity Sciences for Health. Sturmberg has practiced family medicine in Wamberel, Australia for almost 30 years. He has published extensively on the application of systems and complexity principles to health care delivery, health policy, and health systems organization.

Watch the video of the talk:

What makes family medicine complex?

Often we see specialties as more complicated than general practice, but in many ways, family medicine is actually more complex than specialty care. Here’s why:

Health is more than physical well-being

Family medicine physicians are tasked with keeping people healthy, but health is more than the absence of disease. Health is not a static state of well-being, says Sturmberg. Rather, health is a dynamic state based on emotional, physical, social, and cognitive experience that changes from day to day. Therefore, physicians have to deal with not only the patient’s physical complaints, but understand what the patient is dealing with on an emotional level, and understand the environmental and historical context the patient lives in. That’s not an easy task.

“80% of health problems seen in family medicine do not require a medical intervention” – Dr. Joachim Sturmberg

Diagnosis requires careful listening

Because health is dynamic and complex, diagnosing patients’ health problems in general practice is difficult. While specialists know that their patients generally have one of a certain type of diagnoses, general practitioners are constantly confronted with a lot of different issues constantly – the diagnosis could be from a number of problems, both internal and external. Therefore, gaining clues from context – the patient’s daily work, life, environment, family, etc – is critical for understanding what’s wrong.

It only takes about two minutes to listen to a patient’s story, and provides a wealth of important information. Unfortunately, most doctors interrupt after eleven seconds, on average. This is a problem, because reading between the lines is crucial in general practice, says Sturmberg.

“If you are not interested in the person with the illness, you are not really interested in medicine. Many problems seen in family medicine have no easy answers.” – Dr. Joachim Sturmberg

The research paradigm is flawed

In his talk, Sturmberg proposes an alternative research method for studying family medicine called Complexity Theory. Unlike scientific methods that attempt to find linear “cause and effect” patterns, complexity theory is designed for studying systems that are dynamic, unpredictable and multi-dimensional, systems that rarely have linear relationships. Rather than isolating specific variables and testing them in a vacuum, complexity science involves creating models, making predictions, and using further observations to refine or restructure the model.

“The scientific language of systems and complexity is like learning a new language. It’s not easy but we can do it.” – Dr. Joachim Sturmberg

For more on complexity theory, take a look at Dr. Sturmberg’s slides from the talk or visit his website.