Thursday 8 September 2022


A few days ago, Mrs H had a phone consultation with one of our local GP doctors concerning a troublesome affliction. It is not serious enough for referral to a hospital consultant, but some preliminary treatment and investigation is required.

The doctor said she had consulted a flow diagram on her computer which defined what should happen over the next few months, the range of possible diagnoses and the medications required to clarify the next stage of treatment should a next stage be required.

A question inevitably arises of course. How much training would be required for a nurse or pharmacist to follow the same flow diagram? How much training for anyone to follow it? From her phone conversation with the doctor, Mrs H thought it sounded like a procedure anyone could easily be taught in six months or less.

From what we see, a fair amount of work done by GP doctors seems akin to senior managers coming down to the lab to do routine pH measurements.


Macheath said...

If you’ll forgive me quoting myself at length, these flow diagrams have been around for a while. I hope they’ve improved them since the experienced which prompted this post:

“The GP [will often] run through the options in the chart in the given order, regardless of the individual history of the patient.

If something goes wrong with an IT system, you start by eliminating the simplest and most obvious faults - is it turned on? Is a cable unplugged? Only when you have removed all these from the list do you start to look at more complex potential problems, leaving until last the really drastic explanations that might require major intervention or even replacement.

This is the pattern of thinking [by software engineers] that has dictated the structure of online diagnosis charts and, when doctors ignore the clear warnings to use the tool as an aid to practice and make it instead a substitute for rational thought, it costs lives.

In the hands of an idle or indifferent GP, a life-threatening illness can go undetected for months simply because the computer suggests eliminating all minor possibilities first, or fails to list it as an option because the patient does not fit the usual profile.

But, unlike ailing laptops, human beings have an inconvenient habit of becoming increasingly unwell and incapacitated if their illnesses are not correctly treated - or even dying.

And there's no way to switch them back on again.”

A K Haart said...

Macheath - yes that's a good point although it isn't easy to generalise because that idle or indifferent GP is liable to foul up diagnoses with or without a flow chart. We have certainly come across cases where a flow chart could possibly have made a positive difference to diagnostic incompetence.

Any flow chart would have to be more watertight than the average GP which doesn't sound like an impossible goal, but it would also need to be updated in the light of experience. As ever, the real problem is probably incompetence.

Sam Vega said...

I have a sneaking suspicion that doctors relaying the results of a computer flow chart to a patient are a bit like the man with the red flag who walked in front of the first cars. Once people noticed the potential of cars, they started driving faster and soon dispensed with the flag-man. Likewise, the Government will tweak the computerised flow-chart to make it more user-friendly, and you can wave goodbye to GPs forever. And if you're too old, confused, or stupid to understand how the pharmacy link works, you can chat with an incomprehensible Indian bloke who insists his name is Sean.

A K Haart said...

Sam - yes I can see it working out like that. GPs drifting into a situation where they merely arbitrate between patient and computer until the computer is more competent than the average GP. That point can't be far off.

The Jannie said...

Someone wrote that if you could work from a Haynes car manual you could be a pharmacist. I imagine doctoring is a similar challenge.

djc said...

a quarter-century ago 'Expert Systems' were flavour-of-the-month in Artificial Intelligence. What you have described is just that, they didn't work then and they still don't

A K Haart said...

Jannie - my impression of doctoring is that it would be better if doctors came through an apprentice system starting as hospital porters maybe.

djc - I think they can work in a restricted sense but not as originally envisaged because they were over-sold as AI is now. Quantum computing is over-sold too from what I see. And sustainable energy and...