A recent commentary in the Journal of the American Medical Association (JAMA vol 302, p994, http://jama.ama-assn.org/cgi/content/extract/302/9/994) proposes "systems medicine" as a new paradigm for moving medicine "from reductionism to holism." However, commentary itself takes an unfortunately narrow view and primarily biologic view, focusing mainly on the integration of genomics with disease prevention.
It seems to me a true systems approach must address issues at multiple levels that affect patients individually or as communities: biology, personality, communication, culture, lifestyle, socio-economics, and environment. For example, while diabetes risk may be partially related to genetic vulnerability, an individual's risk of diabetes is also significantly mediated by lifestyle factors and socioeconomic factors, while cultural and communication factors may play a major role in his or her understanding of the disease.
This broader view of systems medicine is nothing new to those in primary care. Focusing on first-contact care, long-term person-focused care, comprehensiveness, and care coordination we are already well-positioned to practice "systems medicine". Family physicians, in particular, are trained to address the multiple systems levels that bear on patients' lives and well-being.
Shifting to a truly systems based approach really would represent major advance forward for medicine. But in order to make the first step towards this advance, we must ensure adequate funding, institutional and academic support, and clinical structures to support a strong primary care enterprise.
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