Heroes Not Zombies

The nature of any system cannot be discovered by dividing it into its component parts and studying each part by itself, since such a method often implies the loss of important properties of the system. We must keep our attention fixed on the whole and on the interconnection between the parts

Planck 1936

The Physicist Max Planck wrote this almost a hundred years ago, and he wasn’t the first to make such an observation. Despite that breaking things down into parts and studying them separately is still the predominant approach in the world.

When I studied Medicine at the University of Edinburgh in the 1970s we were taught “Medical Sciences” for the first three years of the six year course. We dissected bodies in the Anatomy class, studied pathological change in tissues and organs in Pathology, learned chemical pathways in Biochemistry and so on. In fact, the first time I saw “cirrhosis” was a diseased liver stored in formalin in a plastic box marked “cirrhosis”. It wasn’t until year 4 that I met an actual patient who had “cirrhosis of the liver”. Maybe all that has changed. But we still practice Medicine by focusing on parts. I often hear from relatives that on a visit to their GP, they are told they can only discuss one problem per visit….so, their asthma today, but come back to talk about their joint pain.

It seems the modern management techniques applied to health care chop the system and the patient’s experience into pieces, sending them to one person for a diagnosis, another for a blood test, another for a prescription, another for advice…..it’s horrendously disjointed. When my dad was in his last month of life in hospital, every single doctor I asked about his progress started their reply with “I’m not your father’s doctor, but I’ll look up his records….” I never found the person who seemed to actually know him.

Yet, we know from research that continuity of care increases both outcomes and satisfaction ratings of patients and practitioners.

In this age where so many people experience multiple “co-morbidities” we need to keep our focus on the whole even more than ever. If we only focus on the parts we begin to believe we know exactly what each drug will do when we prescribe it, yet, not only are the effects different for different people, but in reality, many people are taking multiple medications at the same time (for a multiplicity of disorders)

We need to focus on the whole, and that means giving priority to human beings, their uniqueness and their relationships. It involves trusting doctors and nurses to practice professionally focused on their patients, not on their protocols and clinical guidelines. And we need a lot more whole of life research, which will help us to understand the complexity of the effects of any drug, and the course of any disease in a real person over their lifetime.

It was never a good idea to ignore, or to relegate holistic knowledge. Learning about the parts should include learning about the limitations of learning about the parts.