SFU Canada Research Chairs Seminar Series: "The New Complex Patient? Diseases, Systems, and Interventions"

Abstract

At first glance, the terms ``co-morbid patient," ``dual/multi-diagnosed/co-occurring diagnosis patient," and ``complex patient" seem to apply to the same people-those with more than one specific, single diagnosis. However, a search in medical, allied health, mental health, and social science journals reveals that each term is employed by a specific subset of health disciplines (medicine, epidemiology, mental health, nursing, health services) in research and clinical practice, and that all three terms are used in ways that differ ontologically, epistemologically, and/or methodologically. There is no clear, unified object of study or object of intervention in these terms. Thus, while there is robust and voluminous research in each of the relevant health disciplines about the problem of increasing complexity in medicine, there remains a major conceptual gap because the research is carried out under different epistemological frameworks and for different purposes. This seminar will present some ethnographic findings from completed research in clinic settings, and place these in the context of historical changes in scientific understanding of disease, health actuarial systems, and clinical practice that have resulted in the parallel invocation of `complexity', but possibly incommensurable uses of the concept in research and clinical practice.