Being philosophical when it’s complicated

[摘要] About 20 years ago Plsek and Greenhalgh argued in the BMJ that practice had become more complicated, for both the patient and the practitioner. Recommending the science of complex adaptive systems, they warned against reductive and simplistic approaches to clinical care and service organisation. The articles in this month’s Life & Times not only illustrate the dynamic and complicated nature of primary care but also imply some ways to manage complexity; they unpack the promise and perils of medical language, the importance of understanding situated realities, and the dangers of adopting a naive approach to the complexities of medicine in society.CONCEPTS, IDEAS, AND LANGUAGE Concepts and ideas are important. We use language to express and exchange ideas about the world, even to make sense of it for ourselves. Offering health care, for example, depends on what we mean by health. In 1946, the WHO defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.Richard Armitage shows us how this definition is not only utopian (who can attain total wellbeing?), but also un-nuanced. And yet these three domains of health help us to think about health, especially when we think about them in a nuanced way. How we use words can be as important as what those words mean. Ben Hoban observes that doctors are inordinately fond of nouns. By and large, patients come to us not just with nouns, but also with stories that include them and are driven along by verbs, words of action, backed up by adverbs, pronouns, and so on.The last century saw the wholesale introduction of computing and machine intelligence into medicine. Computers are even more dependent on precisely agreed meanings than humans. Luke Roberts re-introduces SNOMED CT — the world’s most comprehensive clinical terminology. It supports the standardised recording and encoding of patient information, including diagnoses, procedures, and medications. The terminology is designed to be usable in any electronic health record system.

[学科分类] 卫生学