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The Maker Did Not Provide a Dashboard

September 9, 2010

Here’s a paradigm shift in medicine: imagine you’ve got a critically injured trauma patient in the next decade or two.  You’re looking at a screen full of color-coded pixels representing every cell in your patient’s body.  Green pixels tell you that the cell has more than enough ATP for all its needs; red pixels tell you the cell needs more ATP than it has.

 All of the pixels – throughout the entire patient’s display – are green.

 Is the patient in shock?  Do  you need to know anything else (i.e., blood pressure, urine output, base deficit, etc.) to answer this?

 When you think about it, the tests we do in medicine are not the tests we’d like to do.  The things we monitor are only those which we can monitor, not what we’d like to know.

 There is no doubt that there is a great deal of testing in medicine: physiologic measurements and monitors, biochemical testing of various bodily fluids, microscopic inspection and testing of biopsied pieces of tissue, and various types of images of every single body part.  You name it, we’ve tried to inspect.

 Yet, in many cases, we’re not really evaluating what we’d like to evaluate.  For example, we can monitor a number of parameters that assess the circulation’s function: blood pressure, heart rate, central venous pressure, urine output, base deficit, serum lactate, pulmonary capillary wedge pressure, cardiac output, mixed venous saturation, ejection fraction, and end-diastolic volume, to name a few.  But none of these tell us what we really need to know.  If we could know that every single cell in the body had an adequate supply of ATP, we would know the patient is not in shock and the circulation was fulfilling its needs.  It wouldn’t matter what the blood pressure is (unless it’s too high); it’s clearly enough to provide the required energy supply.  Because the maker did not build a dashboard for us to use in managing the ailments of the human body, we have had to develop our own set of monitors to watch, and they’re far from perfect.

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