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EDITORIALS: Nigel Edwards Clinical networks BMJ 2002; 324: 63 [Full text]

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Patient networks and their level of complexity as an outcome measure in clinical intervention.

Rakesh Biswas   (23 January 2003)

Patient networks and their level of complexity as an outcome measure in clinical intervention. 23 January 2003
Rakesh Biswas, Asstt professor,Dept of Medicine Manipal teaching hospital,Pokhara,Nepal,pin-33701 Send response to journal: Re: Patient networks and their level of complexity as an outcome measure in clinical intervention.	There are various yardsticks to measure patient outcome to a clinical intervention. However none of them till date has succeeded in taking into account the infinite variables in the physical and mental realm, a patient’s life pattern can conjure over time. The quality of life is an expression of all these variables and a failure to take all of them into account may give us only a one sided view measured over a period of time. If we take into account instead how much the patient lives (to put all those infinite variables into one word) after the intervention its likely to give us a better estimate of outcome to treatment. Living in general can be construed as a process of building networks of increasing complexity with the infinite variables of thought in the mental realm and bodily sensations (? subjective well being) in the physical realm. With disease as with age the level of complexity starts diminishing like the withering branches of a tree or for that matter like the resorption of dendrites in an aging or diseased neuron (1-2). So with our interactions in day-to-day life, which is brought down to a limited bare minimum so that we immediately recognize how much less, we are living. This itself quantifies our living at that point of time. The only way to possibly document it at this present moment would be through narrative. (3-4) Edwards N in his editorial on clinical networks has dwelled mainly on health care provider networks. This was an attempt to look at clinical networks from a different perspective. References: 1) Lipsitz L.A, Gold Berger AL, Loss of complexity and aging: potential applications of fractals and chaos theory to senescence. Jl Am Med Asso 1992;267:1806-9 2) Goldberger AL, Non-linear dynamics for clinicians: chaos theory, fractals and complexity at the bedside. Lancet 1996:347;312-14. 3) Greenhalgh T, Hurwitz B, Why study narrative? Br Med Jl 1999; 318:48-50 4) Biswas R,Sarkar N, Theodore AM, et al, Developing Holistic health care in the third world: A working study proposal Eubios Jl Asian Intl Bioethics, july 2002,vol 12(4) 143-147 click on:http://www.biol.tsukuba.ac.jp/~macer/EJ124/ej124j.htm Competing interests:   None declared