Another section of this issue of the newsletter discusses old age and loneliness. Closely related to those factors is the concept of multimorbidity, the occurrence of two or more long‐term conditions in an individual, which is a major global concern that places a huge burden on healthcare systems, clinicians, and patients. Multimorbidity challenges the current biomedical paradigm, in particular conventional evidence‐based medicine's dominant focus on single‐conditions. Patients' heterogeneous range of clinical presentations tend to escape characterization by traditional means of classification. Optimal management cannot be deduced from clinical practice guidelines. A paper in the October issue of the Journal of Evaluation in Clinical Practice argues that person‐focused care based in complexity science may be a transformational lens through which to view multimorbidity, to complement the specialism focus on each particular disease. Complexity science focuses on understanding, as a contextualized whole, the many parts of multifaceted phenomena. The approach offers an integrated and coherent perspective on an individual's living environment, relationships, somatic, emotional and cognitive experiences, and physiological function.
Providing this integration is an essential task of the generalist, but is it something that all clinicians need to be able to do when managing patients with multimorbidity? The underlying principles include non‐linearity; tipping points; emergence; importance of initial conditions; contextual factors and co‐evolution; and the presence of patterned outcomes. From a clinical perspective, complexity science has important implications at the theoretical, practice, and policy levels. Three essential questions emerge: (1) What matters to patients? (2) How can we integrate, personalize and prioritize care for whole individuals, given the constraints of their socio‐ecological circumstances? (3) What needs to change at the practice and policy levels to deliver what matters to patients? The authors acknowledge that these questions have no simple answers, but complexity science principles suggest a way to integrate understanding of biological, biographical, and contextual factors to guide an integrated approach to the care of patients who experience multimorbidity conditions. Managing these individuals simultaneously can have significant effects on health professionals themselves. It can challenge their: reductionist basic training; individual clinical and interpersonal competence; practice organization; interdisciplinary working styles; and last but not least, stress and burnout, especially when working with members of persistent chronic disadvantaged communities.