Tuesday, April 17, 2012

A Case for Medical Diversity

Diversity trumps ability.

As described by Scott Page in his compelling book The Difference, the thinking is rather straightforward. Good problem solvers in a field are similar, so a collection of them rarely outperforms any one of them by themselves. However, a diverse group of intelligent people is far more effective, so long as they bring difference perspectives and different methods to bear on the problem.

I considered it a powerful argument for doctors to explore social media: to harness diversity. Specifically, it's an argument for physicians as managers of diverse patient care teams, including nurses, dietitians, and social workers, as well as the patient's family, friends, and other patients like them.

Page outlines four conditions necessary for diversity to trump ability. For each of these, I consider how they relate to healthcare.

The problem must be difficult. Good health is famously difficult, and you need only look at the Dartmouth Atlas to see how they vary.

Individuals must know about the problem. There are a great many people, not just doctors, who know a whole lot about not just the health issue in question (the disease and treatment), but also the patient's habits and values

Incremental improvements must be suggestible by the group. Much of health, particularly for chronic conditions like diabetes and heart disease, are about continual optimizations that could be gathered by diverse suggestions.

The group must be large and genuinely diverse. Many patients, particularly those with chronic conditions, interact with a growing number of healthcare providers.

Tuesday, April 10, 2012

Reasons for Optimism About Tech in Medicine

The DIKW Hierarchy

In David Weinberger's fascinating Too Big to Know, he taught me about the Data, Information, Knowledge, Wisdom hierarchy, which apparently is so commonly referred to that it is better known by it's acronym, DIKW. It's one of those ideas whose power derives from its staggering simplicity. Stated briefly (or, if you prefer, extensively on wikipedia), the idea is that information is more valuable, and more scarce, than raw data, and the same goes for knowledge and wisdom.

The hierarchy says a lot about the perfectly valid concern that the influx of modern technology in medicine is ultimately dehumanizing.

As someone who has could be accused as proselytizing med tech, the hierarchy gave me pause at first. Our fancy gadgets stand to create a data deluge that leaves little room for knowledge and wisdom, which are the stock and trade of medicine. A wealth of information certainly is no substitute for knowing what to do with the information, when, and to what purpose. Those who wonder if more technology is really the answer for medicine must not be casually dismissed as narrow-minded Luddites.

But there is a less obvious application of technology, and this is nicely illustrated with the DIKW hierarchy. Some of our new tools not only collect and dispense more data and information, but transform these into knowledge, any maybe one day, wisdom.

An example is IBM's Jeopardy master computer, Watson, currently being engineered to assist physicians. This tool is interesting because it turns information into knowledge. Far from overwhelming doctors with information, and even farther from attempting to replace doctors, Watson aims to help doctors by reducing the information they're faced with by converting it to knowledge. Ideally, a doctor working with Watson can spend more time turning knowledge into wisdom, and spend less time calculating information from data, or synthesizing knowledge from information.

My guess is that patients would prefer to have their doctor impart wisdom rather than manage data. To the extent that our tools promote this end, we should be optimistic about the future of tech in medicine.

Disclaimer: I receive no compensation from promoting books on this site or anywhere else.

Monday, April 2, 2012

Doctor Digitus: Recipe to Retake a Profession

Published in 1982, relevant in 2012.

In The Social Transformation of American Medicine, Pulitzer Prize winner Paul Starr outlines a medical history wherein doctors were exemplars of professional sovereignty: authoritative, powerful, "unambiguously important to their clients," nourishing their "thirst for reassurance."

Mastery of their profession was easy when doctors' heads were the sole repository of medical information, when medical error rates were not measured or published, and when a doctor's reputation was respected a priori, rather than questioned a Google. Patients had to come to them, in person. With no conceivable alternative, they had to bestow upon them their trust.

Unfortunately, that trust has eroded. Is there a way for physicians to retake their profession?

Simply put, professional mastery tracks with information mastery. In the 1980's, the two cohered: a doctor could master books and journals in a way patients couldn't dream, and control of the profession was unquestioned. Today, the digital explosion has left doctors playing catch-up, with patients arriving at the office with their own list of Web-derived diagnoses.

To retake the profession is to regain information mastery, which is to attain digital dominance: Doctor digitus.

In The Creative Destruction of Medicine, Eric Topol writes about Homo digitus, where the bright future of healthcare is a convergence of patients' digital and bodily selves. For Topol and others, the future of health is digital. Digital digital digital.*

What can Doctor digitorus do?

1- Outperform Google by giving patients the background information on their diagnosis, treatment, and prognosis from good, clear sources created by doctors and/or vetted by doctors.

2- Outperform alternative medicine by connecting with, communicating with, and supporting patients' need to feel empowered and in control of their health future.

3- Outperform scorecard medicine in magazines and online, where reputations hang on the caprices of frustration and marketing, by establishing a robust online presence that drowns out healthgrades.com.

4- Outperform distractions by creating engaging apps and other tools that encourage patients to maintain healthy behavior patterns, from diet and exercise to adhering to treatment regimens.

5- Outperform voter apathy and discontent by using modern media to promote the mission of medicine.

6- Outperform the past with quality improvement tools that measure and highlight avenues to decrease medical errors and avoid avoidable care.

7- Outperform the pace of knowledge-creation with tools that curate valid medical breakthroughs that matter clinically.

8- Outperform traditional medical education by teaching with digital tools.

Every one of these steps involves mastery of digital tools. Which have I left out?

*Don't take it from me, check out some of my favorites