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Slow Medicine: systemic approach to healthcare

Antonio Bonaldi

In ancient times, man and nature were considered as a whole. Little or nothing was known about human body and medicine relied mainly on prayers, offerings and divinatory practices. 

It is with Galileo, Descartes and Newton that we see the disjunction of man from nature. With the scientific revolution man discovers that the world is governed by mechanical laws. The matter is moved by physical forces that respond to precise mathematical laws and the world is like a big machine, the functioning of which can be explained by analyzing the single pieces. 

In the first decades of the last century the mechanistic dogma of the universe-machine crumbles in the face of the new discoveries of quantum physics. In the infinitely small, particles become anarchic and the laws of classical physics related to causality, time and space, prove to be useless. What we see is only the mental representation of a world behind which an intangible reality is hidden: the glue holding together the starfishes and sea anemones and redwood forests and human committees (G. Bateson). 

We learn that reality cannot be attributed to the properties of individual elements. What matters are not the objects, but the infinite configurations that describe their interactions and that form systems which self-organize, transform, evolve and manifest themselves through extraordinary emergence proprieties. 

The era of dogmas and rationalist illusion ends and a new awareness of the mysteries of the world appears but, now, it does not descend from ignorance, but from knowledge. 

What are the consequences of a systemic view of health?

From a systemic point of view, health can be considered an emergent, subjective and multidimensional property. It is the expression of a dynamic equilibrium that is the result of the interaction between biological, psychological and social factors.  

Adopting a systemic approach shows us that everything that happens is interconnected and that reality depend on the properties of the elements it is made and mainly on the interactions that holds them together. Considering both the properties of the objects and their relationships helps us to recognize the complementarity between science and humanism. Science deals with what Bateson called the world of billiards balls, because if you want to know what happens, you look at the magnitude of the force with which a ball is pushed. While humanism, through literature, art, ethics, deals with facts, which are essentially ideas and are intimately connected with feelings, emotions, values, pleasures. 

The impact of human activities on health 
Energy sources, the pattern of agricultural production, eating habits, the way we build houses and cities, transportation, waste management and production and consumption patterns are strongly conditioned by political choices and by individual behaviors that damage the environment and are incompatible with life on earth, peaceful coexistence, health and well-being. It is therefore necessary to acquire an ecological conscience and realize that the health and survival of our species are largely conditioned by respect for nature and its rhythms.

Organisation and management of healthcare
The mechanistic approach is focused on the biological aspects of the disease, relies on technology, specialization, standardization of care and tries to maximize efficiency, time and cost of treatments. This type of medicine is best expressed in the hospital, where problems are addressed one by one, during acute episodes of illness and in controlled environments, where the patient is isolated from family and social context. This is not wrong, but there are health problems that cannot be addressed without taking into account interactions between individual organs, person and environment. Today, a third of the population suffers from chronic diseases, the treatment of which requires a different cultural orientation and territorial organisation. 

Clinical care 
The mechanistic approach has transformed the patient into a set of organs, cells and biological parameters and the prevalent interests of doctors have focused on diseases and their treatment, while the relationship with the patient is completely neglected. Good scientists don’t necessarily make good doctors. Care must be based on scientific data, but it must also benefit from humanistic knowledge. 

The individual plan 
There is no recipe for wellbeing, preserving health, enjoying life and being happy, but some suggestions may be useful: gain awareness that our health depends on the natural and social environment in which we live; that living, growing and dying are not primarily matters of medicine; bring expectations back to reality and accept the idea that life has a certain degree of uncertainty and risk; understand the signals of the body and reevaluate its defensive, regenerative, adaptive and reinforcement capabilities.