Of all the animals of prey, man is the only sociable one.
Every one of us preys upon his neighbour, and yet we herd together.
The Beggar's Opera: John Gay

Saturday, 20 July 2013

The No Hope System (2) - Man vs. Machine

Medicine has certainly come a long way since a doctor would reach his diagnosis by solemnly scrutinising a vial of your urine before sniffing and then tasting it (rather, I imagine, in the manner of a particularly pretentious sommelier; "I'm getting ...hmmm.... asparagus, with just a hint of fenugreek" ).

These days, assuming you have managed to pass the modern-day Cerberus sitting behind the reception desk, you are more likely to find your GP sitting at a computer terminal, ready to access a world of information for your sole benefit.

If it's in the right hands, this is excellent news; specialist appointments or prescriptions arranged at the touch of a button and your entire medical history instantly available without the need for lengthy explanations. In any case, the extent of medical knowledge has long since surpassed the capacity of a single human brain.

However, at least in the experience of friends and family, the availability of medical information online has tempted more than one GP into a lotus-eating lifestyle of intellectual idleness.

There are, it seems, many online diagnostic tools based on the flowchart principle, in which the answers to a series of questions dictate progress through the various options. Much the same things can be found in home health encyclopedias - with the notable exception that, when all else fails the encyclopedia blithely says, "See your doctor".

For the GP attempting to use the system, there is no such cop-out. The anxious patient in the consulting room requires some kind of intervention, so what to do?

In some cases, the answer appears to be run through the options in the chart in the given order, regardless of the individual history of the patient. And in one instance I know of, this course of action was very nearly fatal because these diagnostic programmes are designed by software engineers.

If something goes wrong with an IT system, you start by eliminating the simplest and most obvious faults - is it turned on? Is a cable unplugged? Only when you have removed all these from the list do you start to look at more complex potential problems, leaving until last the really drastic explanations that might require major intervention or even replacement.

This is the pattern of thinking that has dictated the structure of online diagnosis charts and, when doctors ignore the clear warnings to use the tool as an aid to practice and make it instead a substitute for rational thought, it costs lives.

In the hands of an idle or indifferent GP, a life-threatening illness can go undetected for months simply because the computer suggests eliminating all minor possibilities first, or fails to list it as an option because the patient does not fit the usual profile.

But, unlike ailing laptops, human beings have an inconvenient habit of becoming increasingly unwell and incapacitated if their illnesses are not correctly treated - or even dying.

And there's no way to switch them back on again.

1 comment:

  1. What your saying is not far from Bruce Charlton who has mercilessly attacked this Evidence Based Medicine - consulting the literature only to diagnose, rather than know how to do do it the way doctors did.

    It's at the stage though that the trainee doctor is so ill-prepared that he MUST consult the literature in order to get anywhere near a reasonable diagnosis.