Open a new browser tab and check your favorite weather forecast website or app. Right now.
How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not?
Have you ever wondered why they can’t just extend the forecast to a full month? Or maybe even 6 months? Wouldn’t that be way more useful than a 7-day forecast in planning your wedding reception, vacation, or family reunion?
But it doesn’t work. Predicting the weather accurately beyond a week is impossible. Why?
Well, in the 1960s, an MIT meteorology professor named Ed Lorenz, while working on computer models of weather, realized that teeny tiny, almost immeasurably small differences in the numbers he input into his computer ended up significantly changing the long-term weather patterns. Or put another way, his findings suggested that a butterfly flapping its wings in Brazil could cause a tornado in Texas.
This extreme sensitivity of the weather to initial conditions has been termed the butterfly effect. The butterfly effect is why we can’t predict weather accurately beyond a very short time. And, as it turns out, the principles of the butterfly effect apply in all kinds of other areas—from economics to engineering.
So, what does any of this have to do with family medicine? Don’t worry. We’re getting there.
All this butterfly effect and unpredictability stuff is part of the core concepts that grew into what is called chaos theory. Chaos theory has thrown a little wrench into the confidence of traditional Western science. Let me explain.
Sir Isaac Newton, often considered the father of Western science, very successfully solved complex problems through reductionism—breaking a big, complex problem down into two understandable parts, then experimenting with those parts in isolation from the whole system until the fundamental characteristics of those parts are understood. Then, once we understand the nature of all the small parts of the system, we can put them all back together, and thereby understand the system as a whole.
Reductionism works very well in helping us understand the parts of systems. In fact, most of the advances in medicine over the past 400 years have come by a better understanding of the most basic building blocks of the body—understanding gained from reductionism. This success has led to more and more breaking down of the human body into its smaller and smaller parts, hence the current dominance of molecular biology research.
Reductionism also affects the way we, as physicians, think about problems. A human body, as a whole, exhibits all kinds of complex behavior that is very hard to understand. So, with our Newtonian tools in hand, we approach medical problems by mentally breaking the body down into small, more understandable parts, and then trying to find and fix the dysfunctional part. Then, voila! The system is back to normal.
Thinking this way leads us to pursue more and more detailed knowledge about smaller and more-isolated parts or subsystems of the body. We become cardiologists, hepatologists, or neonatal cardiothoracic surgeons. We increasingly become more narrowly focused and more inclined to try to isolate our one specialized part of the body from the body as a whole.
Here’s the wrench that chaos theory throws into the reductionistic party: the whole is more than the sum of its parts. We say it all the time. But, have you thought about what that really means? Do you really believe that the function of the body is more than the parts added together? That there are some global physiologic phenomena that can’t be adequately explained by the behavior of the body’s parts?
That’s what all this butterfly effect and chaos theory stuff is telling us. No matter how good our understanding is of the parts, once you start putting them back together it all gets very complex and unpredictable.
Now, don’t get me wrong: I firmly believe in and rely on medical specialists and subspecialists to help solve my patients’ incredibly difficult, complex medical problems. I love specialists and their inestimable contributions to medicine.
However, the whole-patient approach of family medicine is particularly well equipped for solving some problems that can’t be adequately understood by looking at isolated organs or organ systems. For example, think about a patient with poorly controlled diabetes, depression, and worsening kidney function. Rather than referring to an endocrinologist, psychiatrist, and nephrologist to deal with the problems as isolated issues, a family physician can more easily recognize the subtle interplay that depression, poor glucose control, and declining kidney function have on each other; and thereby, a family physician can formulate a treatment plan that more effectively addresses the problems as the interconnected whole that they really are.
In family medicine, it is easier to see the patient as more than the sum of his or her parts. As a specialty, then, family medicine also provides an inestimable contribution to medicine—especially in dealing with complex, holistic problems.
It’s true that even family medicine is built on the backbone of reductionistic science. And that’s a good thing. Reductionism, though imperfect, is still the best tool we have to understand complex problems.
Nevertheless, if the principles of chaos theory are enough to make the more “pure” scientific field of physics pause and consider whether the traditional approach to complex problems can adequately account for the unpredictability of the butterfly effect, it should at the very least lead us in medicine to question some of our assumptions about our ability to appropriately predict the results of our interventions.
We have conquered many problems in medicine. Chaos theory reminds us, though, that we ought to approach medical problems with a good dose of humility—even within the more-holistic field of family medicine. Next time you add another medication to your patient’s already long list, remember how confident you are in the 7-day weather forecast.
Ben Wilson, MD is a Clinical Instructor in the Department of Family and Preventive Medicine at the University of Utah.