Complex systems also come in children’s sizes

Throughout my master's degree in ‘One Health, Infectious Disease’, I became fascinated by how subtle changes can have drastic impact on the natural equilibrium that protects us, the animals, and wildlife with whom we share this planet.

Infectious diseases exist within complex systems. The systems can be very large, sometimes too large to comprehend. The 2014-2015 Ebola outbreak, for example, was intrinsically tied to population growth, urbanisation, globalisation, deforestation and subsequent loss of biodiversity that brought humans and the host species into close contact. When considering such system complexities, it is clear that serious engagement and cooperation with all kinds of factors is needed when considering the prevention and management of ill health or infectious disease.

During the four months I have spent with the Connecting Care for Children (CC4C) team I have learned that such complexities are in no way limited to the control of infectious diseases. Through a day spent with a team of family therapists, I was able to appreciate that a child lives within their very own complex system. Parents, local community, socio-economic status, schooling, and access to healthcare services all shape not only who children are but also how they will navigate through their childhood.

Specialist segregation exists within and across many disciplines. Sub-specialisation has provided huge benefits, including more knowledge than ever before. Unfortunately, it comes at a cost. The costs include a lack of communication between key players, often resulting in inefficiency. It can also result in a lack of creativity in dealing with complex problems. In many ways, such specialisation reinforces reductionism, the notion ‘that complex phenomena can be explained by reducing them to some more basic level’ Pool & Geissler (2005).

CC4C is providing new pathways within healthcare services for the benefit of the child. An example is in the oral health crisis facing children today. One in four children in the UK today suffers from tooth decay and it is now the leading cause of hospital admissions for five to nine year olds. And yet as a junior doctor when identifying a tooth cavity, I would not know if or how I could make a referral to a dentist. Nor have I ever been shown how to look into a child’s mouth. When sitting at the Royal College of Surgeons, I was part of an important discussion with dentist and medical colleagues on how we integrate the work of healthcare providers (including doctors, nurses, health visitors and midwives), dentists, schools and parents. Although I felt the power of large corporations producing sugary drinks needs to be debated, it was clear from discussion that improved education and communication is needed. This is something that CC4C are trying to implement with integration of dentistry colleagues into the multidisciplinary GP-based hubs.

I have also taken part in a piece of work aiming to identify what matters to parents and carers of under 5s with recurrent wheeze. This has forced us to recognise, as medical professionals, that our conclusions might not be the most significant to parents. We are obliged to think more creatively about how we can help parents achieve the things that are most important to them, ultimately improving their quality of life, whether this means fewer days missed at school, or better communication with GPs and school nurses. This involves working closely with our patients, something the paternalistic origins of medicine intrinsically tell us not to do: making children and their needs the most important.

It has been a valuable experience to spend time in such a forward-thinking department that is challenging the status quo in subtle ways and recognising that perhaps what we are doing is not working as well as it should. It is not easy for professionals to step outside their comfort zone. However when they do, the benefits can be enormous.