Re: how doctors handle the human element

[Benjamin April <ben_april () trendmicro com>]

I think there's a flaw in that logic in that many
of the diagnostic tests we try when debugging
often make things worse or prove fatal. That is a
useful data-point for an engineer. It is just as
useful to a doctor, however based on what we know
of the human body it does not take a reboot well.
Repeated reboots seem to be even worse.



Ben



Gadi Evron wrote:
> 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.
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