The edge of chaos: reductionism in healthcare and health professional training

The human body is a complex adaptive system that by definition is made up of a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents ( 1). This definition can also be applied to a single primary healthcare team, or indeed an entire healthcare system, which throughout the world is becoming increasingly complex. Business and industry have responded to this process by adopting many of the ideas of complexity theory, which emphasises the need to accept some uncertainty, adopt multiple approaches and progress according to what is working best at a local level, which reads very much like a mission statement for primary care. However, healthcare generally has been much slower to respond, and indeed remains dominated by a reductionist approach, which seeks to divide healthcare into small measurable units whether pathological in terms of disease description and career specialisation or financial in terms of quality and outcomes framework (QOF) or hospital episode statistics (HES) data. The inherent weakness of such approaches is the underlying assumption that the 'whole is the sum of all the parts' whereas we already know from complexity theory, and indeed from clinical experience that the sum of all the parts may be much more or much less than the whole, once all these individual parts start to interact often in unpredictable ways. This is not to say that the collection of QOF data is not necessary and useful, but it must not come to dominate the process of clinical practice and research to the extent that it distracts the clinician/researcher from the complex adaptive system before them, i.e. the patient