Systemic thinking: how do we know it when we see it?

One discussion within the field of family-oriented care concerns the distinction between those who practise a family approach and those who think in family system terms. This paper presents a comprehensive model of systemic thinking that may be useful for both family systems teachers and researchers. The conceptual model includes: (i) clinicians' experiences with and attitudes towards family aspects of health problems, and the context of clinicians' judgements about these problems; (ii) the way clinicians organize their knowledge about family factors and health problems in order for that knowledge to be readily available for decision making; and (iii) the interview sequences and hypothesis-generating or testing strategies used by clinicians in encounters with patients. The extent to which clinicians exhibit systemic thinking can be determined through interviews, questionnaires and case materials such as encounter transcripts. A method that assesses systemic thinking allows rigorous evaluations of family-oriented teaching efforts and clinical interventions.