2-17-11 Thursday Day +113

Status:  Feeling fairly well.

Events: At Hopkins for lab checks.  All hematology values look good, but we’re still playing whack-a-mole.  Liver enzymes are still up despite discontinuing antifungal and reducing anti-viral meds.  It may be some GVH (certainly goes along with dry mouth, dry eyes, and dry skin).

  Had a lung CT scan as a follow up, which showed some inflammation in my right lung.  Best guess is a continuing fungal infection, although I’ve been on some pretty powerful anti-fungal drugs for a long time.  It may be that with the return of my neutrophils, we’re just now seeing inflammation in response.  Going back on Monday for another lab check, and have reinstituted my anti-fungals.

  I neglected to mention something that happened Monday that impressed me.  Just when I was about to hop on the table to have my catheter removed the nurse practitioner said to everyone in the room, “Time-out.”  I was then asked my name, birthdate, had my patient ID checked, and asked what procedure I was having.  Several years ago, this “timeout” procedure was started in surgery to prevent medical errors (wrong patient, wrong limb, etc.).  I was pleasantly surprised that Hopkins uses it for minor procedures as well.

Comments:  And on the subject of improving medical care, I was happy to see IBM’s computer program Watson wallop the two most famous winners on Jeopardy.   This prospect augers in an era of using computers to a much greater degree assisting doctors in diagnosing and treating patients.

 Back on in the 70s, Dr. Larry Weed made some radical recommendations of how doctors should engage with the medical system.  One was what he called the problem-oriented medical record, in which you’d list the patient’s problems in the notes on the chart and clearly show your thinking.  He gave it an acronym, SOAP, standing for Subjective, Objective, Analysis, and Plan.  So you might write down S – feverish, sweating, O – temp 101, white count 12,000, boil on right buttocks, A – bacterial abscess, P= culture abscess and blood, start on anti-staphylococcal antibiotics.  Every problem the patient had would be written down the same way, and often you’d find the problems interconnected.

  He also realized that the medical education system was based on stuffing more and more data into doctors’ brains, both a futile and flawed methodology.  He noted that computers could hold much more information, freeing up doctors to use their logical and methodological skills to make sense of an overwhelming amount of information.

  Imagine a Watson packed with every textbook, medical journal, medical image, clinical trial, guideline, and clinical anecdote.  And the ability, as Watson showed on Jeopardy, to correlate them and communicate their value to humans.  Imagine being able to hook up with Watson via your smartphone or iPad.  Instead of having to memorize the differential diagnosis of recurrent paroxysmal atrial tachycardia (as at one time I did) you could use your brain to do more important things, including building a bond with your patient.  I believe the future is bright, and as Ken Jennings wrote underneath his Final Jeopardy answer, “I, for one, acknowledge our computer overlords.” Or as Buzz Lightyear would say, “To infinity and beyond!”

Love,

-Bruce

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6 Responses to “”

  1. Art Ulene Says:

    You make me smile! Good stuff, but let’s get real about doctors…. and how long their huge egos will keep them from admitting that a machine can do ANYTHING better than they can. For some….. infinity is not long enough. Keep up the progress. We send our love….. Art

  2. sheldan Says:

    And, as I like to say, “Buzz Lightyear was wrong.” 🙂

    By definition, you will never get to infinity, much less beyond it.

    If you think about it, infinity is the ultimate “And one.” Name any number, and there will always be a way to add one to it. Or, to put it another way, you may remember the play “Oklahoma” and the auction scene for Laurey’s picnic lunch. Jud Fry (the villain) was trying to outbid everyone for the lunch, and when someone would call out a bid, Jud called out “And two bits!” You might say that infinity will always outbid you by “two bits.”

    Hey, don’t give me an opening regarding anything with math…

  3. Reggie & Fred Says:

    We’re thinking of you guys and hoping those moles are getting pretty tired. Here, “time out” is known as “pause for the cause”!

    We love you and are thinking of you every day!

    Reg & fred

  4. Eileen Breslin and Bill Israel Says:

    Oh Bruce, building a bond with your patients? Perhaps I could interest you in nursing school! Love, E.

    From Bill: Shameless hussy, that! 😉

  5. bob price Says:

    bruce, the hell with all those math wise guys ! You’ve got the right answer, & better yet, the right attitude. ! Up, Up and Away………! stronger, better every day. bob

  6. joel steinberg Says:

    Basically our medical brains have been following algorithmic logic in the realms of diagnosis and treatment since the time of the Egyptians. Perhaps one day computers will make all the diagnoses and figure all the proper treatments for us. But hard to imagine them performing most surgeries. Not enough hand-eye (robot arm-scanner) coordination. Though even now Lasik surgery is done virtually entirely by computer, and radiosurgery with Gamma Knife or Cyberknife is done almost entirely by computer. Maybe we doctors will all be out of work someday. We hope your ongoing problems get cleared up soon. Joel and Margaret S.

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