Complexity in Medicine.
Primary care is practiced with layers of problems, conflicting priorities and uncertain outcomes, the essence of complexity. The complexity is only increasing. A pertinent example being how the one year mortality for congestive heart failure has plummeted from 50% to 10-25%. As a result, every second patient seems to have heart failure clouding the picture. Another example is a rule of thumb that 1/3 of patients takes their prescriptions correctly, 1/3 take their prescriptions incorrectly and 1/3 take them not at all. That last inch of medicine seems to be a yawning chasm across the front door. Yet we happily ignore it. I have observed that many of our tools such as algorithms and pathways are complicated instruments wielded in a complex world.