• 31 DEC 12
    • 9
    Is our healthcare system autistic?

    Is our healthcare system autistic?

    Danny Lieberman, founder of Pathcare, the online service for sharing with people you care for considers the dangers of over-systemizing medical care.

    In a previous post – big data for healthcare is rubbish – I questioned the enthusiasm that the big technology vendors have for big data.

    In this corner, we have hospital administrators, EHR systems specialists, big data for healthcare analysts, insurance companies and HMOS maximizing their  revenue on commodity healthcare sales – and in this corner, we have doctors and patients.

    Healthcare IT helps make information more accessible and facilitates administrative functions such as ordering tests, but it can also be a distraction for doctors and patients; a distraction that sucks up precious time from the clinician’s workday.

    When a doctor sits behind his desk, filling out a clinical issue template in order to enter data into the EHR system – he is looking at a personal computer screen and not at the patient. He’s dividing his attention between a system of software and hardware and a human being (the patient).

    Research performed by Simon Baron-Cohen from Cambridge (Roelfsema, M. T et al.J. Autism Dev. Disord.http://dx.doi.org/10.1007/s10803-011-1302-1 (2011).) suggests that parents who are engineers or computer programmers may have more autistic children than say…musicians.

    Scientists, programmers and engineers view the world through a lens of physical models and system analysis. A physicist collects data, builds a physical model, measures how well the physical model fits the data and draws conclusions.

    In human relationships – you can’t use physical models and systems analysis to determinate what the other person is thinking, or why they’re behaving or how you should relate to them.

    Medicine is not retail. When you relate to another person using system-analysis methods – and ignore the emotional, person and social context of the other person – in a way, you are autistic.

    Engineers, physicists and programmers tend to marry other scientists, engineers and programmers and even though they may not be autistic themselves – their genetic strengths of systems analysis of a world of thing are passed on to their children.

    A study was performed in Eindhoven, (a city with a large population of scientists, engineers and information technology professionals). Examining Eindhoven school records, Baron-Cohen found that children in Eindhoven were 2–4 times more likely to be diagnosed with autism than children living in two other Dutch towns of similar size— evidence that he takes as support for the idea that parents who are strong systemizers could be more likely to have a child with autism.

    Baron-Cohens research has it’s detractors. The research is not at a point where it can identify that the systems-analytic thinking gene is the same gene that is responsible for high-functioning autistic people (people with above-average intelligence and language skills).

    Nonetheless – a frequency of occurrence 2-4x that of children living in similarly-sized towns is more than statistically significant.

    But – even more important it points us to a much deeper understanding of the difference between a world of systems and things and a world of people.

    You can do big data analytics for healthcare and maybe it will tell you something you already know – like there are a lot of obese people in areas with an abundance of fast-food places.

    You can implement a cloud-based EHR system that is really easy to use and accessible for doctors and is cost-effective for scheduling appointments, making e-prescriptions and referring patients for second opinions.

    When doctors ignores the emotional, personal and social context of his patient– in a way, he is autistic.

    When a doctors mind is set on filling the fields in an EHR system template on a computer screen he may be deterred from asking open-ended questions and considering options that don’t fit the template.

    He may ignore the personal situation of the patient; judging a patient on appearances and drawing a conclusion that a person dressed shabbily who has a liver issue and confesses to taking a drink or two before bedtime is an alcoholic.

    On of the most challenging areas of medicine is primary care due the large number of patients with low-risk problems that a doctor sees during his work day.

    Great primary care requires a doctor to be a strong clinician with strong emotional intelligence and the ability to interact with a patient in medical, personal and social context.


    Doctor-patient relationships are not going to improve by improving doctor-information system relationships.


    Doctor-patient relationships can be improved by improving doctor-patient communications.



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