Family Medicine

World Book of Family Medicine – European Edition 2015
Joachim P Sturmberg, MD, PhD
jp.sturmberg@gmail.com
9 – Complexity and Primary Care
Joachim P Sturmberg MD, PhD
A/Prof of General Practice,
Newcastle University, Newcastle
- Australia
Complexity comes from the Latin word complexus; com- “together” and plectere “to
weave” or “braid”. By studying complexity, we aim to understand how things are
connected, and how these interactions relate to one another.
Complexity also entails a particular way of thinking, a change in world view, away
from understanding the whole based on knowledge of its individual parts towards an
appreciation that the parts exhibit different properties to those they display in the
context of the whole. In complex science lingo; the whole is different and more than
the sum of its parts (Fig. 1). Furthermore, the behaviour of system components varies
depending on context; changing context may result in “unexpected” changes in the
component’s and therefore the system’s behaviour [1].
Fig 1: Gauss and Pareto distributions, the basis that define the key differences
between simple and complex world views. Note: the long-tail frequency
distribution and its log-log equivalent are superimposed – modified from West.
(2010) Homeostasis and Gauss Statistics: barriers to understanding natural
variability. J Eval Clin Pract. 16(3):403–8)
Complex systems consist of many different parts (agents) contained within a
boundary separating it from other systems. Hence every system is part of a suprasystem
and itself contains many sub-systems. Systems have permeable boundaries,
providing output and receiving input from their external environment. A system’s
agents are interconnected, interacting in multiple ways; each agent influencing others and in turn being influenced by
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