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Letters Ottawa rules, OK?

The myth of complexity

BMJ 2009; 339 doi: (Published 01 September 2009) Cite this as: BMJ 2009;339:b3505
  1. Tim D Weaver, senior lecturer in mental health services research1,
  2. Sue Patterson, research associate1
  1. 1Department of Psychological Medicine, Division of Neuroscience and Mental Health, Faculty of Medicine, Imperial College London, Claybrook Centre, London W6 8LN
  1. t.weaver{at}

    Thompson’s comment on Bessen and colleagues’ attempt to encourage uptake of the Ottawa ankle rules perpetuates the ubiquitous misuse of the term complex.1 2 Referring to the clinical decision tool as complex detracts from the challenges of achieving change in adaptive systems showing “dynamic conservatism.”3 The delivery of health care entails people and procedures operating in systems designed to achieve …

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