title: Applying a complex adaptive system's understanding of health to primary care.
abstract: This paper explores the diagnostic and therapeutic potential of a new concept of health. Investigations into the nature of health have led to a new definition that explains health as a complex adaptive system (CAS) and is based on five components (a-e). Humans like all biological creatures must satisfactorily respond to (a) the demands of life. For this purpose they need (b) a biologically given potential (BGP) and (c) a personally acquired potential (PAP). These properties of individuals are embedded within (d) social and (e) environmental determinants of health. Between these five components of health there are 10 complex interactions that justify viewing health as a CAS. In each patient, the current state of health as a CAS evolved from the past, will move forward to a new future, and has to be analyzed and treated as an autonomous whole. A diagnostic procedure is suggested as follows: together with the patient, the five components and 10 complex interactions are assessed. This may help patients to better understand their situations and to recognize possible next steps that may be useful in order to evolve toward better health by themselves. In this process mutual trust in the patient-physician interaction is critical. The described approach offers new possibilities for helping patients improve their health prospects.
authors.affiliation: Department of Hepatology, University of Bern, Meikirch, CH-3045, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bircher
authors.affiliation: Department of Medicine 1, University Hospital Erlangen, Erlangen, D-91054, Germany.
authors.forename: Eckhart G
authors.initials: EG
authors.lastname: Hahn
keywords: Meikirch model; complex adaptive system; diagnosis; family medicine; health; internal medicine; primary care; therapy