Abstract
We describe the different categories of systems and systems thinking, and illustrate
why almost all clinical interactions constitute simultaneously complex and complicated
systems, so-called “wicked systems”. We also discuss why they are not amenable to
quantitative analysis. With the use of comparisons and illustrations we show some
of the problems that reductionist metrics create, and support concerns regarding quantitative
fallacy. The systematic correlation of data in medicine was one of the earliest achievements
of the discipline. Recently, however, the overwhelming bias towards an evidence base,
which relies almost entirely on randomised controlled trials, has created a reductionist
view that often excludes important aspects of medicine and, in particular, surgery.
We must now move away from thinking that is controlled by the “tyranny of metrics”
to embrace complex-systems thinking, and work across disciplines. We outline the arguments
for this and give clinical examples from oral and maxillofacial surgery.
Keywords
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Article info
Publication history
Published online: January 24, 2020
Accepted:
December 31,
2019
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
