PETER MOORE: Recognising fifty shades of medicine
I RECENTLY looked up a Jilly Cooper book on Amazon. I admit they are not my usual bedtime reading. The sales pitch told me how it was racing and sexy, full of various rich people jumping out of each other's beds.
At the bottom of the screen was the comment 'People who bought this book also bought Famous Five by Enid Blyton'.
Did I miss out by spending my childhood reading Secret Seven? If I looked up Fifty Shades of Grey would I find readers also ordering Thomas the Tank Engine; what Thomas did with Annie and Clarabelle?
Computers have been described as 'quick idiots'. They will accurately make a link, however strange. It is for us humans to explain why.
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Supermarkets did not introduce loyalty cards to keep customers loyal; it was to look at purchasing patterns. If they knew which people bought which goods they could target their marketing.
One early association, which was a consistent finding, was the link between nappies and beer. People who bought nappies often bought beer. Further research found that dads were being sent out to buy nappies.
With clear instructions, even dads could not get that wrong. Most dads can just about remember the age of their baby. While in the supermarket, dad spotted beer on special offer.
And now this computer linking is coming into medicine with equally logical results. If I type in a medical problem into an NHS web site called the Map of Medicine, a flow chart appears giving me the latest guidelines.
Recently I saw a patient with a needle stick injury. He worked in a nursing home and had pricked his finger. I looked on Map of Medicine and typed in 'needle stick injury'.
Immediately I was given two options — 'neurological determination of the cause of death' or 'caesarean section'.
Although I had yet to carry out an examination, the man sitting in front of me did not appear too dead.
He had walked in looking well and chatting, all signs of life which I managed to spot without even referring to the Map of Medicine.
As a man I thought it was also unlikely that I would need a flow diagram telling me when he would need a caesarean section. I rang the occupational health department and spoke to a real human being. She was very helpful and never even asked whether he was dead or pregnant.
So, as well as the Map of Medicine, should we also develop a sat-nav of medicine? It might help in the examination. If I typed in 'left kidney' a voice might say: "At the umbilicus take the second exit. In another few centimetres you have reached your destination."
If medicine can be carried out using flow charts and maps, why do we need doctors? Couldn't anyone could sit down at a computer, ask questions and manage the problem?
Flow charts and guidelines are useful but limited. A map will show the best and shortest route but sometimes us humans may need a different route. The map will tell me the shortest way from Torbay to Newton Abbot is through Kingskerswell, but when the road is blocked I might take one of the back roads.
The Map of Medicine will give me the equivalent of Kingskerswell; the best treatment.
Sometimes, knowing the patient and family, I might decide there's a better pathway for this particular person.
No one could get in a car and follow the map to Newton Abbot if they have not learnt how to drive. Giving flow charts to people who are not medically trained has been shown to be slow and potentially dangerous. In an attempt to cover every possibility everything is referred to hospital.
Guidelines are exactly what they say on the tin; guidelines —there to guide. Experience and a deeper knowledge of the patient may help me find a better way for that individual.
So the quick idiot of a computer is now a vital part of my job but, like every piece of equipment, it needs a human to interpret the results. I have no idea why a man with a needle stick injury might need a caesarean section. And what did I miss in the Famous Five?