[funsec] how doctors handle the human element
larry at larryseltzer.com
Sun Apr 26 06:40:39 CDT 2009
Have you ever watched the TV show House?
eWEEK.com Security Center Editor
Contributing Editor, PC Magazine
larry.seltzer at ziffdavisenterprise.com
From: funsec-bounces at linuxbox.org [mailto:funsec-bounces at linuxbox.org]
On Behalf Of Gadi Evron
Sent: Sunday, April 26, 2009 4:23 AM
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.
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 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.
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
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
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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