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Family Medicine’s Waltz With Systems

Family Medicine first formally confronted systems thinking with the adoption of the biopsychosocial model for understanding disease in a holistic manner; this is a description of a natural system. More recently, Family Medicine has been consciously engaged in developing itself as a system for delivering health care, an artificial system. We make this new system available to all people, whether sick or well, offering to manage not just their diseases, but their lives. However, a major difference between natural and artificial systems is that natural systems have smooth feedback loops to ensures homeostasis, whereas artificial systems do not. They can only adjust themselves by disruptive adaptive and renewal cycles. Further, Family Medicine aspires to base its creation of this artificial system on the key principles of Family Medicine - continuity, comprehensiveness, and compassionate care in the context of family and community. However, there are another set of principles driving the modern Family Medicine system of healthcare, principles that function like the hidden curriculum of medical education. These principles - risk thinking, health as a commodity, and individual responsibility - are part of a deeper current within healthcare called by some biomedicalization. On closer analysis, many of these characteristics are intimately tied with liberal economies that must grow. Yet this economic system is an artificial system that lacks feedback. It is imperative that we in Family Medicine reexamine our commitment to developing artificial systems.