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Wednesday, April 20, 2011

Physician Answer Syndrome

I was recently reading a post about physician use of clinical decision support titled "Do Decision Support Tools Make Docs Look Dumb?"  What I find interesting about this is that I routinely Google it, or look it up on the web, or in a particular document.

The volume of information that I am expected to be conversant with is incredibly large and includes: Programming syntax details in at least 20 different programming languages, software library capabilities in over two dozen freely available or licenses libraries, the operation and automation of about a dozen different tools, how to administer two different database servers made by different vendors, how to administer a web server, three different UML modeling tools, how to administer an operating system, and how to implement about 100 different standards and profiles.  That's probably not as complicated as being a doctor, but it's still pretty complex.

I try to keep enough of that in my operating memory to do the day to day stuff, and to know where to go when it's no longer day-to-day.  When I don't know, I also know a bunch of others like me who I can ask.

I'm not ever embarrassed at having to look something up, but I'm also rarely ever put into a position of need by someone who has no understanding of my particular art.  Even on those occasions, I'm still not embarrassed.   It's fairly simple to explain that I needed to check something out, and to explain what I discovered.  The translation of the user's need into an appropriate query, and interpretation of the results of that query into something that the end-user can do is quite valuable.

There's an old joke I've heard a bunch of different ways applying to a repairman who is called to fix a problem.  He listens very carefully to the customer who gives quite a detailed description of the problem.  After about 10 minutes of listening, he says, I know what your problem is, and then goes over and makes a very simple adjustment.  His customer is very happy, until the repairman issues the bill.  It's $55 dollars for no more than 30 seconds of work.  The customer is outraged.  "This bill is way too much.  You cannot charge me $55 for less than a minute's work."  The repairman agrees.  "You're right.  Give me back the bill."  He scratches out the $55 and writes the customer a new bill and hands it back.
   Adjusting the Thingamabob:  $1.00
   Knowing that Adjusting the Thingamabob would fix it:  $54.00
The customer paid.

Another great story is physician related.  A doctor has an extremely difficult case.  He calls on a colleague who listens to him go on about the case.  After quite some time, his colleague motions to the doctor to wait, and then steps out of the room and returns with a book.  He reads the doctor the answer from the book, and then closes it and returns it to where he got it, returning back to the room where the doctor is still sitting, now dumbfounded and outraged.  "You are a farce!  You didn't know the answer, you simply read it to me from a book.  You are supposed to be the best in the field.  How can you do that?"  His colleague says "Follow me" and leads the doctor to a large room filled with books.  He waves at the room expansively and then turns to the doctor and says, "Now, which of these books holds the answer that you need?"

The point is, knowing how to solve the problem is what is important.  That includes being able to access the right information that helps you find the solution.  It shouldn't matter whether its a healthcare problem, a computer problem, or a car problem.

If providers find demonstrating that skill to be embarrassing, perhaps they may suffer from a variant of another disorder, perhaps we should call it "Physician Answer Syndrome".

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