Tim Holt
Complexity for Clinicians
Radcliffe Publishing
2004 PB, 169 pages, £27.95, 1 85775 855 2
In the late 1990s, a small number of GPs came together under the auspices of the Complexity in Primary Care Group. United by a common concern for the limitations of the prevailing approach to evidence-based practice, they took their inspiration from the emerging field of non-linear systems dynamics. Converging from an array of disciplines ranging from meteorology to biology and reflected in the study of chaos and complexity theory, it offered new and exciting avenues for exploration that resonated with our perspective of the world from primary care.
With time, individuals developed areas of special interest, but for Tim Holt the pathway seemed clear from the outset of our early meetings. His was to be a pursuit of the application of chaos theory to clinical medicine, a journey that has been characterised by single mindedness and a clarity of thought in an area where others of us have invariably struggled.
In Complexity for Clinicians, Tim explores the theory and practical implications of this new way of thinking from the perspectives of clinical mechanisms and delivery. He suggests that they can offer alternative and in some cases more adequate understanding of health and disease from the perspective of prediction, planning and intervention. These are bold claims in an era of increasing uncertainty and his objective is to bring these theoretical insights to the attention of clinicians while highlighting their practical potential for everyday practice.
The book is constructed in three parts. Part one deals with basic theory. What do we mean by complexity? What is non-linearity? How does chaos differ from randomness? These are difficult and often contested areas which are addressed in a way that is accessible to the general reader.
Part two applies complexity to clinical scenarios and it is here that the book will find most resonance with practitioners. GP, Andrew Innes, explores the application of complexity to the central core of our work — the consultation. He argues that complexity principles resonate with the experience of practitioners in the undifferentiated environment of primary care and can offer a coherent theoretical framework that is more relevant than existing models. Physiology has been termed the ‘mother of chaos’ and the remaining chapters in this section address applications to cardiology, diabetes and mental health. Although studies in all these areas are at a very early stage in their development, the opportunity for classification, pathophysiological understanding and treatment are exciting and potentially of great significance.
The final section explores the way in which complexity modelling might improve the delivery of care at population level by recognising the interactive patterns of clinical variables and their dynamic evolution over time. Although this area is clearly important, the lay reader will find this section challenging and in many areas it lacks the coherence and accessibility of earlier chapters.
It is inevitable that a text in this difficult area will be compromised at times by the conflicting dictates of accessibility for a general readership and a need for academic credibility and rigour. For me, the book's major achievements are twofold. First, it offers an important and unique overview of the potential of complexity science for the clinician. But perhaps, its most important achievement is reflected in the nature of its production. Although Tim Holt is now a lecturer in the Centre for Primary Healthcare Studies at the University of Warwick, the book was conceived and written while he was a full-time GP in rural North Yorkshire; a project that was accomplished during his weekends and without any formal support. From this perspective, Complexity for Clinicians shines out as a beacon for the historical model of general practice research — a witness to the fact that in an era of healthcare re-engineering and academic consolidation, it is still possible to ignite the embers of free-thinking and independent general practice research.
- © British Journal of General Practice, 2005.
