This is an interesting article in the Boston Globe .. about Larry Weed, a guy who many consider to the be the father of the SOAP note (no .. this has nothing to do with web services!).. and certainly a leader in medical informatics. Larry is a dynamic guy and a great thinker. He questions many of the "truths" about medicine, and reveals, I think, some of the true weaknesses of human decision making — specifically that we don't remember everything we learn/read etc.
My recognition of this human fallibility was in fact what kept me away from practicing medicine for so long. As a college student, I avoided courses that would lead toward medical school because I recognized that I didn't remember everything .. and I was fearful that I would make mistakes as a physician. Computers, I found, were more forgiving. Indeed, as we write computer software, we EXPECT to make mistakes. We call them bugs .. and when we work all of them out, our software is (for now) finished and presumably "done right." In this way, software development is an iterative, creative process that we can do without the fear that our errors can have permanent consequences. "oops .. syntax error … recompile .. done!"
I was teaching a class of medical students today and somehow we got onto the topic of physicians as decision makers. The best medical care, I argued, is provided by those who make the best decisions. This is why I'm so interested in medical informatics. We can't make good decisions without good information. Good information about this patient (physical exam, labs, history, etc) .. and good information from the expanse of medical "knowledge" that we have presumably acquired during our years of practice and training. But Larry Weed is right: not only can't we remember it all .. we can't even acquire all of the relevant information due to it's vastness. The point, of course, is that we don't have to.
And so we come full circle to computers. Bring the information to the physicians .. (palm pilots, internet) and we don't have any excuses. Don't memorize everything .. just know where to find it within 30 seconds.
Of course we make the very best decisions WITH our patients .. not for them (or TO them) … and so .. taking a history and doing a good physical exam are important components of information gathering as well as LISTENING to our patients' hopes, fears and preferences regarding their health care.
