Of Doctors and Geeks: Part 1.

As I mentioned recently, I was a diagnostician. My "patients" were systems: hardware, software and networks of various sizes. I usually worked for the small company who wrote the system, and very often my job was to go to the client -usually a fancy-pants bank or Wall St firm and fix a problem on-site, with a stressed-out IT manager flapping nearby wanting to know if it was fixed yet, or when would it be fixed, if the data was salvageable, who was to blame, if I was single,  what the markets might do tomorrow... etc. etc. Not high stress at all, so.


One of my techie colleagues became a good friend. She is a doctor's daughter and said that she had once had a detailed conversation with her dad about the similarities and differences in their respective professions. About how they were both required to find and fix a problem in a pretty complex system.

My friend and I spoke about this recently (unfortunately her dad has since died), and I have been thinking of the subject a lot.  And while medicine and technical troubleshooting cannot be directly compared –the human body and mind is much more complex than anything even NASA or the Department of Defense could put together, there are a lot of parallels, especially when it comes to methods of troubleshooting: i.e. finding the problem.

Having dealt with many, many doctors in the past several years, both for myself and my kids,I have had much more opportunity than most to observe how they deal with troubleshooting complex systems and to note several differences in the approaches used between the medical and the computer world. In fact, I think there is a lot of methods in troubleshooting procedures that we geeks do slightly better than doctors.

I took a step back and tried to analyze why this could be? Doctors have been around far longer than techies have. Even if you include the Industrial Revolution, and apply this experience to tech, doctors still have several hundred years of practice in which they should have honed their craft. I think that is part of the problem. Actually: -I just re-read that last paragraph and realized I used the word “craft”. Very telling. That in itself is another problem. Medicine is not and should not be a craft. In my opinion we have two primary problems:

1. The evolution of medicine over hundreds of years, into which a lot of pomp and bullshit became enmeshed.
2. That medicine is still considered partly a craft or an art –an almost mystical entity, as opposed to pure objective logic and science.

Geeks and techies are not weighted down with that kind of baggage.

So your computer system isn’t working and you are a large bank:  A techie will come in, quickly assess what systems and subsystems are in use, where the (first) break is, and then start to check a bunch of stuff: She will first check that all the bits are connected properly and that all the components needed to run are in place. Then she will run a complete set of diagnostics for all the components. If she does her job properly, nothing is left out of the reckoning.  She will find the first problem (there may be more than one, and start to work outward from there, tracing the interconnecting bits until the system functions again. Then she runs a full set of tests to ensure it is working optimally.

She doesn’t finish the job until it is done. You cannot walk out of a bank saying “I’m sorry. I cannot fix it”. You get on the phone. You bring in more techs. You speak to the programmers. You get patches and fixes made. You stay and fix it until it is working again. Or you replace the broken components.

Failure is never, EVER an option. Period.

A doctor, on the other hand, immediately starts with exclusion based purely on assumption. There are probably tens of thousands of tests that a doctor could potentially run on a human being. There is no way he can run a full set of diagnostics. Therefore he has to start excluding the instant he claps eyes on you. You walk into a doctor’s office and immediately –almost subconsciously, the doctor is assessing you already: height, weight, hair, skin, hands, how you walk, move, how you are dressed, how you present yourself. It all goes into the some internal Patient Processing System: Overweight will probably merit a cholesterol test; underweight may require some vitamin testing, and careful prodding about eating habits.  As you explain the problem, more tests may be included and excluded.  There is a physical examination, further determinations made.

With each subsequent visit and various findings; determinations may be made. And maybe he will find the problem. For 90% of patients this may be the case. But you always have the ones who defy the odds. There is always the other 10%...

People like myself, who looked perfectly healthy, ate well, but actually had mild scurvy. And a bunch of other vitamin deficiencies. A techie wouldn’t have missed that. A techie would have run full vitamin diagnostics, knowing that you can’t tell from the outside (after all, white boxes all look pretty much alike) what the power status actually is.

You may stay a year with this doctor, coming back month after month, trying different medications to see if it helps (and if it does, when we will know it is ____” –don’t even get me started!), dealing with the side effects and with not getting better until the doctor finally does what no technician would EVER do.

He gives up.

He says “I’m sorry. I can’t help you. Perhaps you should see a (insert specialty here)?” 

…and the whole process starts all over again, with nothing lost except a year of your life and a few pints of blood.

If you’re lucky.

Comments

[yanub]

This is great. I should share it with my doctor.

[Lisa Moon]

LOL, this is brilliant! I'm going to share it with my techie, professional nerd friend (and I say that lovingly and respectfully!).

You're quite right, too! When I was reading what you'd written, I thought of a recent incident his team was involved with. My friend works for our provincial government here in BC, Canada. When one of their servers is down, they are _there_ in record time, if not remotely, then in person, doing whatever it takes, for as long as it takes, to get it up and running again (they look after most of the myriad branches of the government, including such huge areas as health and justice dept.).

In fact, on our Thanksgiving, there was an unexpected city-wide power outage. After a while, when the power was not restored and the back-up supplies were running out, this great system of on-call techies was set in motion (with massive protocal, as if it were a natural disaster!) resulting in my friend and many others leaving behind their just made turkey dinners and coming into work on a holiday. They slaved until the wee hours of the morning so that everything would be perfect as usual for all the government employees the next day, virtually all of whom would have no idea that anything had been amiss.

It's amazing how much these brilliant techie folks DO to keep our computerized society running! I note your example of a bank; what would happen if, due to computer error/malfunction we couldn't access our money? A large, national bank perhaps?! Mayhem!

Don't we all wish our doctors could indeed be as systematically thorough and diligent?! I, for one, would like to have my own set protocol for when there is a system failure in Lisa! Automatically, everything would start with the early diagnostics and a team of techies would arrive to take it from there!

Good for you for taking charge and demanding answers. I'll be praying for you to get some real answers, and soon!

[truthseker]

Great- just what we need - doctors who are even LESS human, and more like computers, or engineering nerds.

You even admit yourself that it would be impossible for doctors to run all possible tests on everyone - as you said, "There are probably tens of thousands of tests that a doctor could potentially run on a human being." Unlike "techie tests", which are relatively cheap, tens of of thousands of tests would cost millions of dollars. For each person. You are just not being realistic.

People are not computers, that is why there is an "art" to medicine, not just "science." I think most people think the problem in medicine today is TOO LITTLE art, not too much!