Reframing Medical Complexity
Working in the field of child and youth disability, I often get referrals where the patient has been labelled “medically complex”. It’s a well-known term in healthcare, meaning the patient has multiple interacting health issues. There are usually additional associated factors, such as:
Inequity of access to basic services
Financial pressures
Lack of time to fit in appointments, therapies, work, school and fun
The interpretation of “medical complexity” varies. The doctor might think:
“This will be difficult to manage”
“My workplace can’t handle all of this, so I’ll just do what I can”
“I need to find a someone smarter than me to manage this”
Families have told me they don’t feel the “complexity” label results in better management and are often uncertain of its purpose.
I would like to disconnect the idea of “complexity” from “difficulty”. To do this, we need to reframe the whole idea of medical complexity. Instead of skipping over issues or looking for someone smarter, we need to actively look for simple solutions within a complex network. In other words, connect with the people or agencies that can help. This figure is a good example of a complex network (source). As issues arise, solutions should be approached within the relevant part of the network, rather than by a sole practitioner.
Doctors especially need to go beyond their traditional referral networks of specialists and allied health. For example, if there are barriers to engaging in recreational sport, how about connecting with the sporting club? They are likely to identify issues that a health professional cannot appreciate, and will probably contribute to the solution. It’s important to realise that connections only work if they occur meaningfully. That means talking in real-time via phone, video or in person… but that’s for another article.
This article was written in response to a few questions following my presentation at DFTB Live+Connected