Main description:

This book addresses the principle that successful treatment incorporates a remarkably broad range of clinical variables. Clinicians must identify the extent to which each factor contributes to the success of the treatment process, and how to utilize this information strategically so that their combination enhances outcome.

Complex clinical situations involve numerous macroscopic and microscopic components and their interactions. This book describes clinical practices and variables, that should be weighted according to their relevance for achieving treatment precision and improved results.

The book is divided into sections, each containing topically organized chapters. Sections build from identifying discrete components of the clinical field to combined variables as they impact treatment progression. The clinical narratives that make up the latter part of the book elaborate on the course of care and the challenges involved in managing complex clinical situations. Cases range from primary care patients with systemic medical and psychiatric co-morbidity to more complex cases requiring the involvement of medical specialists, allied health professionals, and multiple health care systems.

Scholarly, practical, and comprehensive, Complexity in Health Care enables clinicians to incorporate previously underappreciated health-related factors into their thinking and practice.

Contents:

SECTION 1 - INTRODUCTION

Chapter 1 - Introduction

SECTION 2 - THE CLINICAL SITUATION

Chapter 2 - The "Clinical Situation," an Introduction to its Structure and Complexity

Chapter 3 - Variables

SECTION 3 - TECHNICAL CONSIDERATIONS

Chapter 4 - Technical Principles of the Paradigm Shift We Adopt

SECTION 4 - NATURE VS NURTURE AND THE EPIGENOME

Chapter 5 - Nature-Nurture and the Epigenome

Chapter 6 - Awe

Chapter 7 - Clinical Decision-Making

SECTION 5 - FURTHER TECHNICAL CONSIDERATIONS

Chapter 8 - Introduction to Clinical Complexity

Chapter 9 - Our Clinical Model: The Place of Underrepresented Factors

Clinical Illustration: Erin

Chapter 10 - The Complexity of the Clinical "Field" Illustrated

Three Clinical Illustrations: A Woman with Chronic Schizophrenia, A Diabetic man, Two Men with Heart Disease

Chapter 11 - Formalizing the Clinical Field

Clinical Illustrations: Seth and Mr. G.

SECTION 6 - SUBJECTIVITY AND INTERSUBJECTIVITY

Chapter 12 - Subjectivity

Clinical Illustrations: Seth and Mr. G. (#2)

Chapter 13 - Complexity in the Clinical Field, Revisited

Clinical Illustration: Mark: Self-Created Complexity

SECTION 7 - WORKING WITH CLINICAL COMPLEXITY, THE EMPIRICAL-COLLABORATIVE METHOD

Chapter 14 - Information Gathering and Integration

Chapter 15 - Clinical Reasoning

SECTION 8 - CREATING AND MAINTAINING A THERAPEUTIC RELATIONSHIP

Chapter 16 - Failure to form a Collaborative Relationship with the Patient

Clinical Illustration: Herb: A Patient with Secrets

Chapter 17 - Our Clinical Approach (taken from SAF's clinical experience), Continued

Steps in a Clinician's Contributions to Patient Change

Chapter 18 - Engaging the Clinical Field: Our Interpersonal Model for Change

Clinical Illustrations: Otto (developmentally disabled) and Matthew (17 year old boxer)

Chapter 19 - Inexplicable Reversals that Facilitate Change

Clinical Illustrations: (1) Seth and Juliana, (2) Nafi

SECTION 9 - TREATMENT, INCLUDING REVIEW OF CASES

Chapter 20 - Complexity in Treatment of Complex Versus Routine Clinical Situations

Chapter 21 -Treatment, Clinical Details

Clinical Illustration: Maggie an Elderly Woman with Vaginal Cancer

Chapter 22 - Interdisciplinary Team Management

Clinical Illustration: Maggie (#2)

SECTION 10 - ASSESSMENT IN CLINICALLY COMPLEX SITUATIONS

Chapter 23 - Introduction to The Role of Assessment in Developing a New Clinical Paradigm

Clinical Illustrations: Two highly accomplished people each with significant depression: (1) A Despondent Woman Who Commits Suicide and (2) Ben, Depression Leading to Paralysis

Chapter 24 - Formal Complexity Inventories, Complexity Assessment Tools

Chapter 25 - Case Detail Presented in Narrative Form Versus Categorical

Assessments: What is Lost? What is Retained?

Clinical Illustrations: Ben (#2) and Thomas

Chapter 26 - Limitations of Complexity Assessment Tools

SECTION 11 - REMAINING GROUPS OF VARIABLES

Chapter 27 - Elusive Variables (#2 Variables):

Anxiety, Mood, Excitement (Sexual and Otherwise), Motivation, and Judgement

Clinical Illustration: Ben, Crohn's Disease (#3)

Chapter 28 - Elusive Variables (#2 Variables), Continued:

Anxiety, Mood, Excitement (Sexual and Otherwise), Motivation, and Judgement

Chapter 29 - Clinical Work with #2 Variables

Clinical Illustrations, Martin and His Problem with Motivation and the Meaning of "Making Love"

Chapter 30 - Detecting, Organizing, and Prioritizing #2 Variables

Clinical Illustration: Jess

Chapter 31 - Creation of a New Model for Clinical Practice

Clinical Illustration: Herb and Jess

Chapter 32 - Random Variables and How They Organize

Chapter 33 - Clinical Judgment

Clinical Illustration: Herb and Jess (#2)

SECTION 12 - CLINICAL JUDGEMENT

Chapter 34 - Clinical Judgment, Continued

Clinical Illustration: Jess (#2)

Chapter 35 - Clinical Judgment, Illustrated

Clinical Examples: SAF and Others

Chapter 36 - Cultural Values, i.e., Mores, Ethics, Standards, and Habits

Clinical Illustration: Kamile

SECTION 13 - #3 VARIABLES

Chapter 37 - A New Category: #3 Variables, Beyond the Elusiveness of #2 Variables

Clinical Illustration: Londyn

Chapter 38 - Toward a Comprehensive Discussion of #3 Variables

Clinical Illustration: Kamile (#2)

SECTION 14 - THE EMPIRICAL-COLLABORATIVE (E-C) METHOD

Chapter 39 - The Empirical-Collaborative Method

Our Method for Using Clinical Data to Arrive at a Paradigm Shift for Clinical Practice

Chapter 40 - The Empirical-Collaborative Method Illustrated

Clinical Illustration: Ben (#4)

Chapter 41 - The Empirical-Collaborative Method and Its Fit with Clinical Complexity

Clinical Illustrations: Seth (#3) and Mark

Chapter 42 - Using the Empirical-Collaborative Method to Arrive at a Paradigm Shift

Clinical Illustrations: Kamile (#3) and Erin

Chapter 43 - The Empirical-Collaborative Method and the Paradigm Shift, Further Illustrated

Clinical Illustration: Kamile (#4)

SECTION 15 - UNDERSTANDING AND WORKING WITH CLINICAL COMPLEXITY

Chapter 44 - Excessive Certainty by the Clinician

Clinical Illustration: Carol

Chapter 45 - Achieving a "Real-life" Understanding of a Case

Clinical Illustrations: Jennifer and Carol

SECTION 16 - SYNTHESIS, PATH ANALYSIS

Chapter 46 - Use of Path Analysis to Map out Complex Clinical Situations

Chapter 47 - Mapping Out Jennifer's Case Using a Path Diagram to Schematically Represent a Complex Case

SECTION 17 - CONCLUSION, CLINCHING THE PARADIGM SHIFT

Chapter 48 - Slowly Emerging Details

Clinical Illustration: Michael

Chapter 49 - Giving Up One's Assumptions in Pursuit of a Paradigm Shift

Chapter 50 - Concluding Thoughts