Between life and death, the key lies in diagnosis

In medicine, the reality is that human judgment, even an expert’s, could fall well short of certainty

October 08, 2017 12:01 am | Updated May 26, 2021 03:22 pm IST

“I learned about a lot of things in medical school, but mortality wasn’t one of them,” wrote the medical professional Atul Gawande at the start of his bestselling book, Being Mortal. True. Keeping alive both hopes and beings is what this fascinating profession strives to do. Yet, despite the adulation and admiration for the noble profession, I always have a feeling that it is an imperfect science — life or death depends on the kind of decisions these semi-gods take or make, based on conscious learning and unconscious knowledge. At the end of the day, the questions will be: ‘Are there always wiser decisions? Could the choices have been better?’ There is always the chance of erring; for, human judgment, even an expert’s, could fall well short of certainty.

There have been attempts to overcome this situation. With advanced technology it is believed that artificial neural networking can make sophisticated clinical decisions.

The first to moot this idea was William Baxt in the 1990s: he suggested that expert systems learn from experience as much as humans do. He believed their guesswork could be improved by incorporating feedback from each success and each failure, and that computers can outperform doctors in diagnosing heart attacks. In a later study led by Lars Edenbrandt of the University of Gothenburg, Swedish cardiologist Ohlin H. was pitted against a machine. Out of 2,240 ECG procedures, the doctor correctly picked 620 while the computer could do only 738. Machine beat Man by almost 20%.Diagnosis is the keyword. It pains when lives are lost due to wrong diagnosis. Five years back, an eminent cardiologist lost his life to liver sclerosis. This, when he himself was an expert in the diagnostic methods of angiogram and angioplasty procedures and he had the best facilities at arm’s length. His physician-father was well-known for giving spot-on diagnosis but he had chosen to override his father’s suggestion. It ended in an irreparable loss. We may then put the blame on fate.

Such fatal errors in judgment occur all the time. Luckily some of them have better endings. Thanks to a good physician’s intervention, my husband escaped from acute renal failure, wrongly diagnosed as gastro. A well-meaning orthopaedic surgeon forced my friend to cancel her full-knee replacement surgery. According to him, contrary to another expert’s diagnosis, there was a need only for a half-replacement, less cumbersome and less risky. Though they had to get it done in another city, the result was positive.

Another one was still better. A middle-aged aunt of mine, a mother of three, got her bloating stomach diagnosed as tumour and discovered on the operation table that it was live — her fourth child. The story may sound ridiculous; since she was past the conceiving age, they assumed it was a problem with her uterus. The ‘growth’ is 35 years old now, and herself, a mother of two!

It’s no wonder then that they say an architect’s error is covered with ivy and a doctor’s, with sod. Imperfect science indeed.

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