Micrognome joins Gr8 Deb8 (debate)

Micrognome joins Gr8 Deb8 (debate)

This week Sir Charles Gairdner Hospital was the site for the most recent local skirmish in the battle between clinicians and Dr Google. Two teams of academic clinicians engaged in debate for and against handing over the future of medicine to Dr Google.

You might have thought Dr Google would be an easy target for a bunch of clinicians arguing their case in the hospital in front of an audience based on the clinical research association. But the result was a little too close for complacency. In the words of the Iron Duke; it was a near run thing.

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The genome is all you need

The clinician versus Dr Google debate highlights a growing trend to use Google and other search engines as a diagnostic aid before consulting their doctor.  The modernists, led by a home-grown Nobel laureate, argued that the conventional clinician would soon become extinct as a diagnostician. To their way of thinking, the clinicians were dinosaurs and would lose the debate. Their argument favoured the unstoppable pace of technology, where the $1000 genome was everything. Web-delivered, rule-based decision algorithms would soon replace the traditional clinical interview.

Why you need a diagnostician

Happily, the debate went in favour of the Micrognome and his friends.  Friends of the cyberchonriacs lost .. this time.

Winning arguments that carried the day were:

  • Clinical diagnosis is a complex decision-making process
  • It relies on critical decision skills founded on a system of logic
  • It takes years to learn and needs continual refinement
  • Practitioners need professional accountability
  • Reliable cheap alternatives do not exist.

The dangers of a clinical GPS (Google Physician System)

The Micrognome told the audience what happened when he plugged the symptoms of a recent patient into the Google search engine. Using lay terms, the first response was a carefully moderated professional website that advised seeking a physician’s advice. The second response explained how you could treat condition with a home remedy. In this specific case, that could have had fatal consequences. It brings to mind how slavish adherence to GPS instructions can have you going in the wrong direction down a one way street.

The clinician as story teller

Unfortunately, the cut and thrust of a debate is not the best environment for reflections on clinical logic or medical epistemology. The posts on this blog have raised some of the issues previously. NB the truncated clinical decision process denoted by the acrostic AIDA: assess, investigate, decide, act. These are four functions of clinical practice beyond the reach of virtual medicine. Perhaps we are also missing the point that the most effective clinicians are great story tellers. They craft the patient’s verbatim account of their illness into a personal story that compels a specific course of medical action. It is worth noting that it is the doctor who is the historian; not the patient. And with that comes a burden of responsibility.

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But let’s not sit on our laurels. Let’s keep the debate going, to the benefit of both sides.

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