I am still thinking about this subject . In part one, I discussed how a geek never quits and a doctor will. In this installment, I will attempt to explore why these differences exist, and what patients can do to ensure a higher quality of care.
Lets take an example from my life: My right arm has suddenly and without warning stopped working. This has happened to me twice in my life. Needless to say, it is a very disturbing thing to have happen, especially if one happens to be in a business meeting taking notes at the time. That was the first time. I tried not to panic and tried not to cry, and my hand slowly regained function a few minutes later.
The second time it happened was much more recently and I happened to be in the hospital at the time. I mentioned my non-working hand to my roommate, she observed that the non-functioning hand was a completely different color to the working one. She called the nurse; the nurse called the Head Nurse and the Head Nurse called the doctor.
Now, here is how a Geek would approach this problem:
Problem: Hand doesn't work
It this a local or general problem? Local - owner appears OK.
Establish integrity of basic hand subsystems:
Then a geek would go though each of these, checking first that the communications were intact, and the hand was sending and receiving signals from the brain. Actually I tried to do this. I -trying to keep as calm as I could- checked to see if I could feel touch in that hand. I could.
Next a geek would try and check the power -which in a hand would be the circulation. If circulation checks out, she would go along muscularskelatal; checking for breaks or any problems in the joints where power or communication might get cut off.
If all that checks out OK, she would probably look at the central control system: i.e. the brain.
So there I am, sat on the bed of the hospital, unable to use my hand at all. I am telling my fingers to move, and they are sitting there like five little lumps of meat, My roommate is freaked out. One nurse is clearly freaked out and the other is quiet and thoughtful. I am trying not to panic, but the tears start despite my best efforts. However, I stay calm.
The doctor comes in.
"What's the problem?"
"A chorus of "I/She can't move my/her hand" from the -now four- women in the room.
"When did this start?"
"A few minutes ago. I can feel sensation, but I cannot move it."
"And her hand is a different color" -piped in the roommate.
And the doctor stares. He is quiet, then sighs. He doesn't touch me. He looks at my tear-streaked face, perks up and says-half accusingly, half-hopefully: "Are you depressed?"
Four women in that room look ready to punch him.
Looking back, I realize now that this doctor had no inclination or interest to deal with my non-working hand. He was trying to pass me -like a hot potato- off to a shrink. Or ANYONE. Then I would be Somebody Else's Problem and he could go back to whatever he was doing.
Thinking back on that incident, and on many like it I realize that that's another big difference between geeks and doctors:
Ownership and the willingness to take it.
It was drilled into me during Geek training, that if my client had a problem, then it was MY problem and MY responsibility to fix it. We were encouraged to take ownership of problems and to see them through to their conclusion. Even if I could not fix the problem myself; if I passed it to a programmer or someone else, I still owned the problem, and I was responsible for its resolution.
It is Management 101. You can delegate tasks, but you cannot delegate responsibility.
Doctors never went to Management school. They never had this pointed out to them.
Neither did most patients.
Most patients think that -like the geek, the doctor is responsible for finding and fixing the problem.
This is often NOT the case. In the United States at least, the patient usually holds that responsibility. Yes. The patient has ownership of their own problem. They may delegate the task of finding and fixing the problem to the doc. Now, many doctors will step up and take in upon themselves to manage the problem. But this just niceness, or good manners. it is not protocol (that I can tell) or their obligation. Their only real obligation is to do no (further) harm. So they are not obliged to fix the problem -just to not make it worse. Most regular people don't understand this. It is never explained to people that the responsibility to fix the issue lies with the sufferer, not with the physician.
Most people grow up with their own notion of that a doctor is or should be, probably based on books or TV shows. I thought they were all like that old dude in "The Little House on the Prairie". My family doctor in Ireland was like that. He was a kindly man involved with our lives, as much as he could be, considering we only went to see him if someone was at death's door, or if blood was gushing or something was hanging off. He understood the family history. He made house calls and everything. If there was a problem, he would do his best to find and fix it.
Of course the reality today is very different. Nowadays medicine is a business like any other, and most doctors don't answer to themselves or even to their patients but to Insurance Companies. This is never explained to patients. They are left to figure it out on their own.
It took me forever to work out this fundamental break between doctor and Geek ideology. And it is not the only one. Many geeks -even if they don't own the problem, will hunt it down to the bitter end for the sheer intellectual challenge. Or they will want to find the error or the break in their code for pride in their work.
I sometimes wonder why many doctors do not have this same curiosity and drive? I wonder if it is a personality thing? I wonder if there is a particular type of people who are recruited or accepted into medical school; a type far different from those in Engineering school? I don't know, but it is an interesting question.
Next up: Advocacy. This probably won't be until after the Thanksgiving break, during which I will probably be loudly giving thanks while silently praying for the strength not to kill someone...