The balance of a complex dynamic system: Application of the problem map in a case of multiple morbidity

Abstract

Introduction: This case report is of unique importance in general practice because the decision is made in the context of great uncertainty. The dilemma of the individual decision is particularly relevant in situations of greater complexity, such as multiple morbidity. The Case: octogenarian with multiple morbidity constituted by the coincidence of some health problems uncommon (rheumatoid arthritis, psoriasis, Wolf Parkinson White syndrome, arterial insufficiency of the lower limbs), which complicates the clinical decision. Through the map display problems can be the repercussions of adding new diagnoses (heart failure, renal failure, dysthymia, hypothyroidism). In this patient, the increased number of problems which are not always morbidity multiple stood for more serious clinical situation. On the other hand, a small fluid or electrolyte imbalance with hyperkalemia had disastrous repercussions that culminated in hospitalization for adverse reaction to therapy (toxidermia). This internment contributed to the rebalancing of the system and now the patient is clinically stable. Discussion: The clinical decision in situations of multiple morbidity is an exercise of great complexity. Using the Map Problem, as recording media, it is possible to view the problems and want to establish the relationship between them, both priorities. This approach facilitates the development of a plan adjustable. The reported clinical situation allows us to verify the dynamic balance of living systems despite the apparent chaos.