
Complex, Complicated, Chronic ailments
The distinction between “complicated” and “complex” is important here; situations in which attending to many intricate details is necessary for success are “complicated,” whereas situations in which attending to the same details will not reliably reproduce success are “complex.”
These conditions include but are not limited to;
-Conditions that are life threatening: cancer, heart disease, stroke, and HIV/AIDS.
-Conditions that cause serious disability without necessarily being life threatening: stroke, closed head or spinal cord injuries, mental retardation, and congenital malformations.
-Conditions that cause significant pain or discomfort that can cause serious interruptions to life activities: allergies, migraine, arthritis, and sickle cell disease.
-Conditions that require major commitments of time and effort from care-givers for a substantial period of time: mobility disorders, blindness, Alzheimer's disease and other dementias, chronic obstructive pulmonary disease, paraplegia or quadriplegia, Down's syndrome, and depression.
-Conditions that may require frequent monitoring: diabetes, conditions requiring anti-coagulation treatment, severe asthma, severe allergies, and schizophrenia and other psychotic illnesses.
-Conditions that predict or are associated with severe consequences: hypertension (associated with heart disease), depression (associated with suicide), diabetes (associated with blindness, kidney failure), and alcohol and other substance abuse (associated with intentional and unintentional injuries).
-Conditions associated with negative consequences for someone else: high-risk pregnancy (risk to new-born), HIV/AIDS (risk to sex partner), and tuberculosis (risk to community in general).
-Conditions that affect multiple organ systems: HIV/AIDS, cancer, and diabetes.
-Conditions that require management to "tight" physiological parameters: conditions requiring anti-coagulation therapy, type I diabetes (possibly type II also), and kidney failure.
-Conditions whose management requires coordination of multiple specialties: breast cancer, depression co-morbid with serious medical conditions, multiple sclerosis, and cerebral palsy.
-Conditions whose treatment carries a risk of serious complications: most cancers, and other conditions requiring complex surgery.
-Conditions requiring adjustment in a "non-medical environment": mobility disorders, blindness and other sensory disorders, Alzheimer's disease, and frailty.

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COMPLEX, COMPLICATED AILMENTS AND RARE DISEASES
Treating Physicians or Primary care physicians have a critical role in complex chronic care. Supporting primary care's essential functions in that role means minimizing barriers while maximizing the use of effective resources. Effectively managing complexity in primary care means anticipating and responding to the sources of complexity: the diversity of patients' knowledge, goals, resources, and family and social contexts. Adaptability rather than standardization should be the cornerstone of complex chronic care. For many patients, this adaptability requires a multidisciplinary team that is tailored to the particular practice and its setting. Such team-based care should be led by primary care physicians.
