Systems and Causal Loop Thinking in Medicine: From Healthcare Delivery to Healthcare Policy Making

Abstract

The human body is regarded as a system of high complexity, not only because it is consisted of millions of interrelated and interdependent functional units -the cells-, but because it is also an evolving system. It changes over time, initially to achieve the full growth of organs and bones but subsequently as a response to environmental factors to retain its vital internal indexes stable, to achieve homeostasis. In this context, the in depth understanding of the connections between these indexes that drive the dynamics of the system is crucial. Yet, malfunctions occur and their accumulation causes diseases, which are regarded as internal crises that due to tight relations between the different organ systems, affect various body parts. The application of systems and causal loop thinking while combating diseases is examined and the need to treat not the body part that is ailing, but the patient as a system is underscored through examples of diseases. The importance of examining the risk and trigger factors of diseases from a systemic perspective is also highlighted through examples from the medical literature. The patient itself is viewed in the context of the Swiss Cheese Model and the causal agents that lead to a system failure and patient harm are examined, as well as ways of strengthening the healthcare system in order to minimize the vulnerabilities and the possibility of failures, with particular regard at modelling doctor-patient relations as Paskian Conversations. The Triumvirate of Public Health concept is discussed as a valuable practice in the healthcare policy making sector, regarding both top-down and bottom-up modes.