SYSTEMS THEORY SYSTEMS Defn: * A set or arrangement of things so related or connected as to form a unity or ORGANIC whole as the solar

system, irrigation system, supply system etc. * The body considered as a functioning system. * A set of facts, rules, principles arranged in a regular, ORDERLY form showing a logical plan linking various parts. A number of bodily organs acting together to perform one of the main bodily function as in circulatory system. To understand circulation requires understanding parts and system.

Engel (1980) gives the example: * * The label "Red Blood Cell" implies the larger system in which it exists. Nothing exists in isolation be it a cell or a person. Each belongs to a system (i.e. a set of things (facts, rules, principles) so related or connected as to form a unity or organic whole). Every system is influenced by the configuration (i.e. by the arrangement of parts, form or figure) or the system of which it is a part. Engel's biopsychosocial model. Fig. 1 & 2.

Figure 1 Hierarchy of Natural Systems SYSTEMS HIERARCHY (LEVELS OF ORGANISATION) BIOSPHERE 1

SOCIETY-SUBCULTURE COMMUNITY FAMILY TWO-PERSON PERSON (experience and behaviour) NERVOUS SYSTEM ORGANS/ORGANS SYSTEMS TISSUES CELLS ORGANELLES MOLECULES ATOMS SUBATOMIC PARTICLES

In the hierarchy of natural systems each level in the hierarchy represents an organized dynamic whole. The name of each whole reflects its distinctive properties and characteristics like: * * * * * Cell Organ Person Family Society 2

* *

Nation Universe etc.

Each system has its own distinct qualities and relationships at that level which require their own unique criteria to study them. For e.g. Methods and rules for studying what constitutes the cell are different from those for studying functioning of the cell(s). Each system has its own unique characteristics and dynamics as a part and component of higher level systems. * In scientific work the investigator selects one system level on which to concentrate or begin. For the physician/nurse that system level is always PERSON: the Patient. The modern physician is trained in medicine under the BIOMEDICAL model of patient care. Biology and Medicine = Biomedicine. Biomedicine is characterized by factoranalysis i.e. where the patient is reduced to elements or constituents that make males or females, and not what makes a female or male PERSON. (e.g. biological science).

The biomedical model does not make provision for understanding the person as a whole: i.e. with a . social, . psychological nature and a . set of beliefs, perceptions and views about the world/universe (i.e. in the earth and its inhabitants), the cosmos (i.e. the universe considered as a harmonious and orderly system) etc. Engel says "The crippling flaw of the biomedical model is that it does not include the patient, his/her attributes as a person; a human being" predictions in biomedicine require that the human being be reduced first to elements or constituents that make up his or her mind and body "i.e. reduced to physico-chemical terms before they can have meaning". The neglect of the whole (person) in the biomedical model is largely responsible for; (a) physicians preoccupation with BODY AND DISEASE 3

(b) (i) (ii)

the corresponding neglect of the patient as a person. This has contributed to: the public view that scientific medicine is impersonal the biomedically trained physician viewing science and scientific methods of investigation as having to do with understanding and the treatment and disease AND NOT with patient and patient care.

The factor-analytic approach of biomedicine has served well to identify, characterize in detail and with precision the constituent components of the body-mind systems. But the systems characteristics of each component part of any system must also be studied. Different approached are required to gain understanding of rules and forces for the collective order of a system, whether an organelle, a cell, a person, or a community. As Weiss says: These cannot be understood merely as an assemblage of constituent parts. Engel goes on to say; "Many of the data necessary for hypothesis development and testing are gathered within the framework of an ongoing relationship. These data appear in behavioural and psychological forms in relation to how the patient behaves and what he reports about himself and his life". Because of what he terms the shortcomings of the biomedical model Engel then presented; the biopsychosocial model as an alternative to the biomedical model

STUDENT EXERCISE

the story's impact or consequence on the wellbeing of the a) the patient, family, community etc, b) the health system c) you as the clinician