funsec mailing list archives
Re: how doctors handle the human element
From: Gadi Evron <ge () linuxbox org>
Date: Sun, 26 Apr 2009 14:53:12 +0300
Larry Seltzer wrote:
Have you ever watched the TV show House?
On occasion
Larry Seltzer eWEEK.com Security Center Editor http://security.eweek.com/ http://blogs.pcmag.com/securitywatch/ Contributing Editor, PC Magazine larry.seltzer () ziffdavisenterprise com -----Original Message----- From: funsec-bounces () linuxbox org [mailto:funsec-bounces () linuxbox org] On Behalf Of Gadi Evron Sent: Sunday, April 26, 2009 4:23 AM To: funsec Subject: [funsec] how doctors handle the human element Today I wrote a blog post named: Debugging for Medical Doctors. In retrospect, I think it shows the difference between handling technology and handling humans, performing the same action. Debugging for Medical Doctors What's debugging you ask? When you know there is a bug in your program, you find it by the process of debugging. How do medical doctors do it? And how they may be doing it wrong. To debug, you: 1. Observe symptoms (a program getting stuck, crashing or giving you wrong results). 2. Locate where the problem is (usually piece of code which causes the mess). 3. Fix it. All three basic steps can be much more complicated than they sound. You may need to work hard to understand what symptoms you are seeing. You may break your head trying to figure out what's causing them, and you may waste even weeks trying to fix the issue. Doesn't the process sound familiar to how doctors diagnose to reach a prognosis? They: 1. Look for symptoms, trying to observe the patient and question how the patient feels. 2. Perform tests to get a clearer understanding of what the problem may be. 3. Prescribe drugs, a workout, a diet or even surgery, trying to treat the problem and/or its symptoms. Medical doctors can be perfect and still reach the wrong prognosis, for several reasons. Observation Outside signs can be misleading and caused by something unrelated, or by several different illnesses. Patients may not know how something feels, or how to describe it. "Where is it? The heart? The stomach?" "How does it feel? Does it scratch? Itch? Burn?" Many of us humans are not very aware of our bodies and how we feel. Our emotional spectrum may be limited to just "sad" and "happy". Guiding a patient through this discovery process can't be easy, and is not necessarily a part of how medical doctors are trained. Locating Locating the problem can be a repeat of Observation above, only with more fine-tuned tests, such as a blood test, a biopsy or even *shaking in boots* exploratory surgery. The results can bring back no new information, be a definite answer, or provide yet more symptoms to add to the puzzle, helping to analyze what the picture looks like. Fix it! Fixing illnesses is not always possible even if doctors do find out what they are. It's possible that a cure has not yet been found, or that all you can treat is the symptoms and hope to alleviate the originating issue. If you can't, it may at least be possible to mitigate the pain, or to help the patient reach a better quality of life. The problem is, debugging doesn't stop there. A medical doctor will try to treat illnesses by how likely they are, as symptoms can suggest many different answers. What is the most likely answer by looking at the symptoms? Then, what is the most likely of these to be present in this particular patient, say a 5 years old girl? Does the medical history tell us anything? Has the patient done anything out of the ordinary? What of trends of illnesses in recent history? Then, is it likely to get a rare rain-forest disease in New york City? (Okay, bad example. Phoenix?) Prescribe the likely solution, don't over-do it as you worry about side-effects and how the solution will impact the patient, or achieve the opposite goal. Schedule a follow-up examination. If solution fails, proceed to the next one until symptoms abate. Does that sound reasonable? It does, but what of emergencies? Say the patient reaches the hospital near death. The doctor may need to "fire in all directions" and hope for the best. I met doctors in my life, and while many of them were very smart, many of them also had no idea what proper debugging looks like. This is best described by a story of what a friend of mine went through. He described his symptoms to the doctor and the history of what was tried to resolve the symptom before, as no one discovered its cause up to that point. The doctor listened patiently and then prescribed SIX different drugs and said "let's try all of these and see what works." While this is obviously an extreme case, my friend, an engineer by trade, was shocked. He may not understand medicine, but he understands debugging. That's not it. Say the symptoms stop, which of the prescribed drugs do you stop? Another question which pops to mind is: How do you know if the result was not due to a combination of two of the drugs? Three? Humans are not easy subjects. As my friend Ryan Russell (BlueBoar) said on twitter, perhaps they need to be taught how to better describe symptoms. As my friend Inbar Raz mentioned on Facebook, the human body is not a friendly interface to debug. I wouldn't want to have to be the one doing it, but than again, I didn't attend seven years of medical school. Making sure a doctor knows how to do proper debugging is basic, and more important than most of anything else he or she can be taught. This is what medical school is about, but obviously something gets broken by the time many doctors finish medical school. Finally, a raging opinion. There is not much we can do about many doctors being elitist snobs, and honestly, with as many patients as they need to see in a day I don't blame many of them for having this shield around them. The main downside I see is that they can not accept being corrected by the layman patient. Many of them would rather say a symptom is psychosomatic than admit they are wrong. Do I blame them for this human trait? No. But as someone who will go see a doctor as a patient, I don't have to like it. Unlike computer code, the human body is where we live. This is one black box we want to be careful with. Doctors are usually responsible, but some just don't know how to do so properly. My friend described above said it best: "Doctor, you are an expert. When I have car problems I go to a mechanic and while he sees hundreds of cars like mine--I know my car best--and it is making a sound that wasn't there yesterday. I can tell you it is coming roughly from an area 'here', but that's where my expertise end. I know my body best, and I come to you for help with what I feel." The computer is engineered, and we know what it is made of (at least in theory). The human body is being reverse engineered, and we still have a long way to go. Medical doctors are technicians--granted, very smart and able technicians--but technicians non-the-less. Teach doctors proper debugging. _______________________________________________ Fun and Misc security discussion for OT posts. https://linuxbox.org/cgi-bin/mailman/listinfo/funsec Note: funsec is a public and open mailing list.
_______________________________________________ Fun and Misc security discussion for OT posts. https://linuxbox.org/cgi-bin/mailman/listinfo/funsec Note: funsec is a public and open mailing list.
Current thread:
- how doctors handle the human element Gadi Evron (Apr 26)
- Re: how doctors handle the human element Larry Seltzer (Apr 26)
- Re: how doctors handle the human element Gadi Evron (Apr 26)
- Re: how doctors handle the human element Paul Ferguson (Apr 26)
- Re: how doctors handle the human element Michael Simpson (Apr 27)
- Re: how doctors handle the human element Benjamin April (Apr 27)
- <Possible follow-ups>
- Re: how doctors handle the human element Robert Slade (Apr 26)
- Re: how doctors handle the human element Larry Seltzer (Apr 26)