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Nobody is an island Embracing complex interactions in the context of comorbidities
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  • Ben de Bock,
  • Kees Pieters,
  • Henry Weinstein,
  • Dick Willems
Ben de Bock
Amsterdam UMC Locatie AMC

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Kees Pieters
Dirksen University of Applied Sciences
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Henry Weinstein
OLVG
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Dick Willems
Amsterdam UMC Locatie AMC
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Abstract

Rationale, aims, and objectives Decision-making for patients with comorbidity is neither an individual nor an only once matter, as it takes place repeatedly within in a network of care providers. It is true that in an acute phase specialists occupy a central and predominant position, but later care providers increasingly rely on each other to share the needs and concerns of their patients. The question this study tries to answer is what fosters or hinders contact between healthcare providers in the various phases of their patients' hospitalisation. Method Practical experiences of caregivers from different disciplines are examined using both narrative theories and aspects of complexity thinking. The focus is on the factors that influence the manner in which caregivers establish and develop their relationships. Results In the curative phase, the primary physician communicates top-down decisions and instructions to healthcare providers under his authority. The involvement of a multiplicity of disciplines triggers an entanglement of dichotomous voices. Eventually centralized coordination patterns give way to a less dominant coordination. Conclusions Patients with comorbidity require close cooperation between an increasing number of healthcare providers. This cooperation can only be enhanced by recognising the complex of relationships between these caregivers. Research into these practices can benefit greatly by using methods, which relate methods of complex and narrative-thinkers.