Submit comment Finally some hard-to-disprove evidence that general practice is indeed more complex than other medic Joachim Sturmberg , Wamberal, NSW - Australia A/Prof of General Practice, Monash University - Australia Congratulations to Dr Katerndahl and his team, for their great work, and for their extraordinary stamina to procure publication 8 years after submitting this paper (1). This is a very dense paper detailing an important new research approach for the field, and linking this to many important issues affecting general practice care with its unique adaptive properties. This paper especially deserves credit as it, for the first time, tackles to measure, what most general practitioners/family physicians have long experienced and described, the high complexity of clinical care they provide. Having listed the many elements of the “complex consultation system” in the one paper provides the necessary detail to appreciate why general practice is so complex, meaning interconnected with the diversity of the human experience of illness. This is the point that connects this work with the essence of “the business of medicine”, understanding health as a complex adaptive state (2 -3) of high complexity. Specific diseases are less complex states, and it is the loss of complexity that defines many specific conditions, e.g. heart failure or arrhythmias (4). Appreciating the great variability, and hence great complexity, amongst patients visiting a general practitioner cannot be overemphasized (5). It should therefore be of no particular surprise that consultations for only a specific condition are less complex and hence less demanding and potentially less effective for the overall health of the patient (6). The complex nature of primary care and the less complex nature of secondary care is of particular importance to the understanding and the planning of the health system at large – not only are the demands on the different providers very different, so are the requirements for resourcing the required interconnected services at this level, an insight that especially health system planners have to gain (7). We are at the starting point for a complexity based practice of medicine. References 1. Katerndahl DA, Wood R, Jaen CR. A Method for Estimating Relative Complexity of Ambulatory Care. Ann Fam Med. 2010 July 1, 2010;8(4):341-7. 2. Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766-9. 3. Topolski S. Understanding health from a complex systems perspective. J Eval Clin Pract. 2009;15(4):749-54. 4. Goldberger A. Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet. 1996;347:1312-4. 5. Sturmberg JP, Siew E-g, Churilov L, Smith-Miles K. Identifying patterns in primary care consultations: a cluster analysis. J Eval Clin Pract. 2009;15(3):558-64. 6. Stange KC, Ferrer RL. The Paradox of Primary Care. Ann Fam Med. 2009 July 1, 2009;7(4):293-9. 7. Sturmberg J, O'Halloran D, Martin CM. Systems Can Only Do What They Are Designed to Do - Health Care Reform In Australia. NAPCRG- Meeting; Montreal2009. Competing interests: None declared ... less Published August 15, 2010 Replies to A Method for Estimating Relative Complexity of Ambulato... http://annfammed.org/content/8/4/341/reply 1 of 1 23/08/2015 12:02 PM