BMJ  2005;330:92-93 (8 January), doi:10.1136/bmj.330.7482.92-b

Letter

Evidence based medicine: does it make a difference?

Management of complex systems needs new approaches

The first 150 words of the full text of this article appear below.

EDITOR—Gabbay and le May's study on how primary care practitioners decide and use knowledge identifies a polarisation in healthcare research and development.1 On the one side are those who see health care as a linear system that can be understood by reduction to its component parts with a simple relation between cause and effect. On the other side are those who see the system as inherently complex, in which input and output relations are uncertain but patterns emerge that could not be predicted on the basis of analysing the underlying parts.

Although the subject is in its infancy, non-linear systems theory is beginning to offer new approaches to investigating complex systems.2 3 The trick is to match the analytical approach to the complexity of the system under study. Complex environments need regulatory systems that match their complexity. The current modernisation agenda reflects a reductionist approach that inhibits the development . . . [Full text of this article]

David P Kernick, general practitioner

St Thomas Health Centre, Exeter EX4 1HJ Sul838@eclipse.co.uk


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care
John Gabbay and Andrée le May
BMJ 2004 329: 1013. [Abstract] [Full Text] [PDF]

Access jobs at BMJ Careers
Whats new online at Student BMJ