Dear Editor,
I hope the policymakers will listen – improving parts without improving the system as-a-whole invariably means making things worse (1).
It is high time to approach our problems with a systems thinking mental framework – everything is connected to everything else, and nothing can be understood without simultaneously understanding its context. The flaws of health systems – anywhere in the world – can no longer be overcome by fiddling at the edges, especially those motivated by bean counters looking at balance sheets. Medicine is a deeply human endevour – its essence is not the blind application of science and technology, but rather the wise application of those to support our work to meet our patients biological, emotional, social and sense-making needs (2,3). Practicing human medicine requires time – time to think, time to reflect, and time to create personal meaning, for both our patients and ourselves (4). Without it our work result in more patient distress, and our own disillusionment resulting in cynicism and burnout.
Failing to do so may well be even worse than the dystopian catastrophe described in our colleague Richard Young’s novel 2060 (5). What we need is fundamental health system redesign that results in a person-centered, equitable and sustainable healthcare (rather than disease-management) system (6).
References
(1) Ackoff RL. Systems thinking and thinking systems. System Dynamics Review (Wiley). 1994;10(2/3):175-88. https://dx.doi.org/10.1002/sdr.4260100206
(2) Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766-9. https://dx.doi.org/10.1111/j.1365-2753.2009.01225.x
(3) Sturmberg JP. Health: A Personal Complex-Adaptive State. In: Sturmberg JP, Martin CM, editors. Handbook of Systems and Complexity in Health. New York: Springer; 2014. p. 231-42. https://dx.doi.org/10.1007/978-1-4614-4998-0_15
(4) Sturmberg JP, Cilliers P. Time and the consultation – an argument for a ‘certain slowness’. J Eval Clin Pract. 2009;15(5):881-5. https://dx.doi.org/10.1111/j.1365-2753.2009.01270.x
(5) Young R. 2060. Lubbock, TX: Wild Lark Books; 2023.
(6) Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.
Re: Matt Morgan: The NHS needs to be less efficient