Complexity in primary care: understanding its value. Kieran Sweeney. Oxford: Radcliffe Publishing, 2006 (v + 165 pp). ISBN 1 85775 724 6.

To be frank, how complexity theory can help the general practitioner in his or her daily work would not be immediately obvious to most bag-carrying GPs. In this book, an exceptionally erudite academic GP, Kieran Sweeney, takes the reader on a journey through the development of scientific thinking and scientific medicine. The starting point for this journey is a single consultation with an older woman with diabetes and hypertension, where Sweeney attempts to apply positivist evidence-based medicine (EBM), but has to confront the lack of relevance of it to the patient in her context. As he describes it, it is a conflict between a biomedical and a biographical way of understanding the world.

Sweeney’s central proposition is that the explanatory model that dominates thinking in modern scientific medicine — the ideas of positivism, reductionism, and linearity in cause and effect — do not adequately explain the complex world in which we live. In building his argument for a paradigm shift, Sweeney takes us on an eclectic trip through the development of medicine from Hippocrates to EBM, which he sees as a culmination of the positivist tradition. His critique of EBM points out the way in which knowledge is constructed and understood, then dictates the questions that are asked and the knowledge that is valued. The description of the mathematical basis of complexity theory that follows is at times beyond this reader, but Sweeney communicates the basic concepts of complexity theory well — the importance of interactions, complex systems and their capacity for self-organisation and emergence, which describes the potential for complex systems to generate properties that could not have been predicted from their initial components.

In the last sections of the book he describes applications of complexity theory to health care systems and to clinical practice. This is the least developed section of the book and the reader is left with the feeling that the process of application is just beginning. This book is certainly not a light read but is full of ideas and new ways of thinking.