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Below Our Radar

September 13, 2010

It is a huge paradigm shift in medicine to understand the difference between what we should know and what we actually can know.

 Rocket scientists are lucky.  When they fire off a missile into outer space, it seems that they can know and monitor just about anything.  In putting together that incredible electromechanical device, the engineers also built in sensors, detectors, and gauges all designed to sense whether any problems are developing.  This allows the astronauts, scientists, and engineers operating the missile to intervene and correct the problem before a catastrophe develops.

 Your doctor is not so lucky.  First of all, the human body comes to him already turned on; he doesn’t even get to do any error-checking during a boot-up sequence.  Once it has started, he can never do a reboot to correct any problems.  Most importantly, it is very difficult for him to know if anything is wrong until a real problem emerges.

 For example, when you get a cut on your hand, the doctor has a choice of 1) cleaning it up and suturing the wound shut or 2) letting it heal in from the base.  The former option is more likely to provide a less disfiguring scar; the latter option will reduce the chance of infection.  In most cases, closing the wound works out well.  In making this decision, the doctor can only hope that he’s cleaned the wound adequately prior to closing it.  Ideally, he would know exactly if any bacteria are still in the wound and in what concentration.  He would also know – again, ideally – which antibiotics are best at killing the specific bacteria in the wound.  With such knowledge, he would always be able to close a wound with complete confidence that an infection will not occur because there are no organisms left lurking in our tissues. 

 Yet, we don’t have that information because we did not invent, design, or build the human body.  If we had, we would have built in the sensors and detectors we would need for these and the trillion other decisions we make in health care.

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