A/Prof Carmel Martin
Monash Health

An Australian medical graduate from the University of Queensland, Professor Martin completed a Masters in Community Medicine at the London School of Hygiene, University of London and a PhD in Epidemiology and Population Health at the Australian National University. Professor Martin is in active clinical practice as a general practitioner. Her research in Australia, Canada and Ireland has focused on reforms related to chronic care and complex systems. Her interests, research and implementation and evaluation cover a wide range of systems based interventions, underpinned by complex adaptive systems theory and social constructionist perspectives. A particular focus is to improve chronic illness trajectories. This involves modelling and predicting illness and wellness, resilience, tipping points and deteriorations using complex systems theory and IT systems. She is the Joint Editor in Chief of the Handbook on Systems and Complexity in Health (Springer Verlag) and the Forum on Systems and Complexity in Health in the Journal of Evaluation in Clinical Practice (Wiley) with Associate Professor Joachim Sturmberg, University of Monash.


Title: Resilience, Tipping Points And Frailty In Patient Journeys

Life is maintained through a multitude of regulating networked systems that ensure our dynamic functioning and keep vital parameters within safe limits. Systemic resilience is the capacity of this complex system to bounce back upon challenges, ultimately determining the chances of survival or living well. Understanding systemic resilience is challenging, but essential for modern medical practice. 

All individuals, but particularly those with significant compromises to their biopsychosocial and or environmental states face particular challenges to their resilience related to physical strain, food intake, infections, societal challenges and any number of other stressors.  Stressors may be acute and severe or cumulative and may create a tipping point into frank decompensation. Resilience reflects the dynamics of resistance to deterioration and capacity for recovery.

Critical slowing down (because of loss of resilience) in response to noxious internal or external stimuli is demonstrated in a wide range of health related contexts. Examples include:
self-rated health and readmission or risk of death; beat to beat variability in heart rate; domestic violence, frailty; and mental illness. In fact, much of healthcare involves monitoring for signs of deterioration or restabilisation, or risk minimization. However more attention to resilience in these processes are likely to be enhanced by emerging scientific approaches to avert destabilisation occurring and to optimise recovery with the least disability and distress. 

This keynote outlines significant areas of investigation in identifying, measuring and predicting loss of resilience and tipping points into decline, often requiring acute medical interventions.