Medicine's Unfinished Revolution. Part 1—The Case for Change: Systems Thinking and the Soul of Medicine

ABSTRACT

Medicine has historically progressed by addressing anomalies that its prevailing conceptual framework could not explain, subsequently expanding that framework to incorporate them. This essay, the first of two, contends that the current anomalies confronting medicine—chronic multimorbidity and suffering arising from the interactions between conditions and lived experiences—are fundamentally different. These challenges cannot be resolved by merely broadening a framework designed to isolate components, as they represent anomalies of interconnection and interdependence. What is needed is not an expanded biomedical frame, but an entirely new conceptual approach. Drawing on systems and complexity sciences, this essay differentiates four phenomena that medicine often conflates—health, illness, dis‐ease, and disease—and introduces the somato‐psycho‐socio‐semiotic (SPSS) model, which conceptualises health as a dynamic equilibrium rather than simply the absence of pathology. The consultation is redefined as the fundamental unit of care, and the health system is reconceptualised as a purpose‐driven organisation, described as a health care vortex, centred on the patient's experience of health. The argument is illustrated through the case of a single, representative patient and concludes by identifying unfinished work at three levels: the physician, medical education, and medicine's social license. A companion essay addresses the common objections to this argument.