Larry Seltzer wrote: > Have you ever watched the TV show House? On occasion
> > Larry Seltzer > eWEEK.com Security Center Editor > http://security.eweek.com/ > http://blogs.pcmag.com/securitywatch/ > Contributing Editor, PC Magazine > [email protected] > > > -----Original Message----- > From: [email protected] [mailto:[email protected]] > On Behalf Of Gadi Evron > Sent: Sunday, April 26, 2009 4:23 AM > To: funsec > 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. > > Observation > 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 > 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. > > Fix it! > 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 > symptoms. > > 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 > I feel." > > 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. > _______________________________________________ > Fun and Misc security discussion for OT posts. > https://linuxbox.org/cgi-bin/mailman/listinfo/funsec > Note: funsec is a public and open mailing list. > > > _______________________________________________ Fun and Misc security discussion for OT posts. https://linuxbox.org/cgi-bin/mailman/listinfo/funsec Note: funsec is a public and open mailing list.
