Primary care defined by uncertainty

Carrie Bernard

doi:10.46747/cfp.7103213

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RE: Use chaos and complexity science to understand complexity and uncertainty in medicine, health and beyond, and to make a better world.
Vivian Rambihar

Published on: 15 April 2025

Published on: (15 April 2025)
Page navigation anchor for RE: Use chaos and complexity science to understand complexity and uncertainty in medicine, health and beyond, and to make a better world.
RE: Use chaos and complexity science to understand complexity and uncertainty in medicine, health and beyond, and to make a better world.
Vivian Rambihar, Cardiologist, Univ Toronto, Adjunct Assistant Professor Medicine, Div Cardiology
Dr Carrie Bernard’s President’s Message seeking solutions to the crisis in primary care amid uncertainty worldwide, and “crisis within other crises” identifies “uncertainty and complexity as defining features of the primary care paradigm,” with “family physicians finding solutions in the presence of uncertainty on a near daily basis” (1).

Dr Sarah Fraser’s Editorial “Family medicine is complexity medicine” mentions Nicole Wood’s discussion on “providing excellent care for the simple and the complex” …and “remaining capable in the face of uncertainty and ambiguity” (2).

We responded that all medicine is complexity medicine (3), and previously proposed that medical students should learn chaos and complexity science to understand and work with or work around complexity and uncertainty, for issues in medicine as well as global issues and crises (4).

Dr Sarah Fraser and Dr Tricia Greenhalgh proposed coping with complexity and educating for capability (5), and there are now leadership courses on teaching complexity to better handle and even thrive in our increasingly complex and uncertain world.

Uncertainty and complexity are part of medicine, health, society and the planet, increasingly so, and medical students, health professionals, and everyone else could learn chaos and complexity science to better deal with our increasingly complex and uncertain world.

A 3 decade experience with this is described in a Conference Poster “Chaos, Complexity,...
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Dr Carrie Bernard’s President’s Message seeking solutions to the crisis in primary care amid uncertainty worldwide, and “crisis within other crises” identifies “uncertainty and complexity as defining features of the primary care paradigm,” with “family physicians finding solutions in the presence of uncertainty on a near daily basis” (1).

Dr Sarah Fraser’s Editorial “Family medicine is complexity medicine” mentions Nicole Wood’s discussion on “providing excellent care for the simple and the complex” …and “remaining capable in the face of uncertainty and ambiguity” (2).

We responded that all medicine is complexity medicine (3), and previously proposed that medical students should learn chaos and complexity science to understand and work with or work around complexity and uncertainty, for issues in medicine as well as global issues and crises (4).

Dr Sarah Fraser and Dr Tricia Greenhalgh proposed coping with complexity and educating for capability (5), and there are now leadership courses on teaching complexity to better handle and even thrive in our increasingly complex and uncertain world.

Uncertainty and complexity are part of medicine, health, society and the planet, increasingly so, and medical students, health professionals, and everyone else could learn chaos and complexity science to better deal with our increasingly complex and uncertain world.

A 3 decade experience with this is described in a Conference Poster “Chaos, Complexity, Complex systems, Covid -19: 30 Years Teaching Health Professionals Complexity” available online, and a free book online “Tsunami Chaos Global Heart: using complexity science to rethink and make a better world.”

Learning chaos and complexity could help us understand complexity and uncertainty in medicine, health and beyond, and help us to make a better world.

References
1) Bernard C. Primary care defined by uncertainty. Ed. Canadian Family Physician March 2025; 71 (3) 213; DOI: https://doi.org/10.46747/cfp.7103213
2) Fraser S. Family medicine is complexity medicine. Ed. Canadian Family Physician January 2024; 70 (1) 7; DOI: https://doi.org/10.46747/cfp.70017
3) Rambihar VS, Rambihar SP, Rambihar VS Jr. Medicine is chaos and complexity medicine. eLetter Response https://www.cfp.ca/content/re-medicine-chaos-and-complexity-medicine.
4) Rambihar VS. Medical schools should teach chaos and complexity thinking. BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2412 Available as BMJ Rapid Response https://www.bmj.com/content/382/bmj.p2052/rr-3
5) Fraser S, Greenhalgh T. Coping with complexity: educating for capability. BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7316.799
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Competing Interests: None declared.