The authors of ‘Complex consultations and the edge of chaos’ (Innes et al)1 are to be congratulated on making complexity theory accessible and on linking it so clearly with the consultation process. In these times of over-rationality and managerialism any explanatory model that helps GPs to acknowledge and make use of the inherent uncertainty of front-line encounters is to be applauded. However, I couldn't help but feel that this was just another way of conceptualising the importance of the unconscious in human behaviour and interaction, as understood through a basic knowledge of psychoanalytic theory. The ‘edge of chaos’ of complexity theory may be the same as the ‘flash’ of insight that the psychoanalyst Michael Balint and his colleagues taught previous generations of GPs to generate and use in short consultations.2,3 This is not a criticism of complexity theory; indeed, if several different theoretical perspectives all point to the importance of working with uncertainty and non-rational behaviour this not only highlights the importance of such interventions, but allows general practitioners to base it on the theory that they feel most comfortable with. Having at last grasped what complexity theory is, I look forward to the deepening of understanding that will come about as it is tested out in practice.
- © British Journal of General Practice, 2005.
