I'm beginning to think that all of this depends on the level at which we are
enquiring. We can regard the consultation as one level of a nested
hierarchy: society/ health service/ StHA/ PCT/ Practice etc. Each of these
is complex at its own level.

Similarly the participants are complex entities. Not only that, but parts of
each entity (for instance my pulse and blood pressure control) are complex
and chaotic. It's probably the same for individual cells, and at a
sub-cellular level too.

Perhaps some of the difficulty of thinking about the consultation as a CAS
is because of lack of clarity about the level of enquiry.

My view of the consultation is about ideas. Last year I saw an asthmatic
patient with a complaint of chest tightness. The idea that 'this might be
angina' came into my head, but was dismissed: I treated asthma. A few weeks
later she gave the same presentation (apparently) to a colleague who
referred to a cardiologist. I recently saw her after discharge from hospital
following an urgent cabg operation.

My question is why was the idea of '?angina' not strong enough to emerge
into my synthesis, when it was a few weeks later into another doctor's
synthesis. I think that complexity theory is appropriate at this level. I'm
not sure if it is at some of the other levels mentioned. Nor am I sure that
the nesting of levels is fractal or self-similar, although there is a huge
number of layers.

I guess it all depends on how you look at it.

Paul

Paul Robinson
General Practitioner, Scarborough
GP Consultant Sowerby Centre, Newcastle
Hon. Senior Clinical Lecturer, Leeds

-----Original Message-----
From: Complexity and chaos theories applied to primary medical and social
care [mailto:[log in to unmask]]On Behalf Of
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Sent: 24 April 2002 21:42
To: [log in to unmask]
Subject: Re: Consulting as a CAS?

Could the language of
Complex adaptive systems be another way
To avoid thinking about the way that we relate
To our patients and them to us.

When I am inside the consultation
I find it hard to make the language work for me.
I am wondering if the model may even
Create more barriers to my thinking who
I am in the consultation.


Most irritating :-)


For me :-))))


Simulations of the interaction may be interesting
A bit like videoing.

Using models of complex adaptive systems
As a way to reflect on the complex processes
And to practicing doing things differently.
A sort of virtual role play.

This simulation may well be possible....

I am trying to get a guy to come and
Demonstrate genuine simulation models
That companies and organisations can actually use
To come along to one of the Tufton meetings
In the autumn


Alasdair