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Sunday, June 17, 2007

First, do no harm 

This is the post where I hope all my doctor friends don't read my blog. Or perhaps that they do read my blog, but don't take it personally.

Colby Cosh, editorialist for the National Post, posted a little note on his blog about an outbreak of C. difficile in Quebec hospitals.

That's a classic iatrogenic disease: the usual mode of transmission in hospitals seems to be doctors bringing it with them from patient to patient.

His editorial is pretty hard on the doctors involved in that case (and similar "forgot to sterilize the instruments" fiascos elsewhere in the country), but it should be.

Medicine, sadly, probably is in need of a bit of procedural clean-up. Rather than rehash the work of others, I'll let the incredibly smart Alex Tabarrok over at Marginal Revolution do the rest of the writing for me:

In Praise of Impersonal Medicine, on using procedural checklists to improve diagnosis and treatment, because process control is better than instinctive doctoring.

Why is Medicine so Primitive?, on how we need to make medicine much more mechanistic and procedural than it is now, because it would save more lives.

The only personal note I'd inject here is that one of my doctor friends, a bone-surgery guy deep into his career, was telling me that he's at the point where he basically specializes in one surgical operation, and he does it well.

This is probably how more doctors should be, and surgeons especially: take one operation, get very very polished at it (maybe do it for ten thousand hours?), and away you go.

Is there any room for doctors to consider, for lack of a better word, holistics? I mean, sure, I could get a doctor to fix my wrist, but it would be better if he understood why I was injuring it in the first place and maybe fix my _shoulder_, the root cause.

(I just made up that example off the top of my head; my wrist and shoulder are, AFAIK, fine.)
Well, my amateur impression is that we have reasonably good numbers on life-or-death outcomes (got antibiotics for your pneumonia and lived; got C. difficile and died...) but vaguer numbers for vaguer outcomes such as your example.

I don't see any reason why a procedural, expert-system process couldn't have elements like "wrist pain is often caused by shoulder problems."

That said, usually if you have a problem that doesn't go away, you get sent to a specialist: physio, oncologist, whatever. They've got a different set of procedures and areas of expertise.
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