Saturday, January 11, 2014

Incompetence vs Common Sense


I'm angry.  I'm as angry as a hornet's nest that just got hit by a rock thrown by a 10 year old that has no idea what they just did.  Oh, there may be no intent of harm, but someone is getting stung.

Here's the current situation.  A 70+ year old person I know woke up a few days ago and fell in the bathroom.  We will call her M.  M was knocked unconscious for a moment.  M's spouse responded and called 911, the medics arrived and took M into the Forsyth County Hospital in Winston-Salem.  The medics were wonderful, very courteous and professional.  M was throwing up and had vertigo on the way to the hospital.  At the hospital she was treated and admitted for tests and observations.  When I talked to M, and she described the event it appeared to me that she had not had a stroke, they had done a CT scan and it was normal.

 I'm not a doctor, and have no medical training, yet I've never played a doctor on TV.  But I do work in the health care industry, not as a clinician, but as a software development team coach and organizational improvement consultant.  My disclaimer stated... here is my diagnostics after about 10 minutes conversation with M and just a few pieces of data from the event and the tests.  M awoke and fell (an accident) from no real medical condition such as a stroke, etc.  When she fell she hit her head and the jarring knocked her ball bearings loose - the inner ear's ability to balance is upset, and is treated by a therapist that moves the head in a very precise manner.  I suggest this diagnosis and that M would be OK in a few days.

Well getting your ball bearing rattled is not a very scientific term - but M seemed to understand and it helped explain a possible cause and treatment.  The next day after more tests and observation in the hospital M was treated for Benign Paroxysmal Positional Vertigo.  Yeah, that sound like the right technical term -- who's idea was ball bearing getting knocked around.  "David you ignorant geek" -- Dan Aykroyd.

During her stay at Forsyth County Hospital M had many tests (CT, MRI, Heart Monitor, etc).  Turns out M is quite healthy and all the test prove this.  She was treated twice by a PT for the inner ear calcium deposit that are causing the vertigo.  And she was discharged.  At home she is doing well and all is back to normal - well almost.  M still has vertigo - note the phrase positional.  Also note that the calcium deposits must be reabsorbed by the body so that they quit interfering with the balance organ in the ear.  This will take days or weeks.

Here is what makes me mad as a hornet's nest.  In the thousands of dollars of testing and observation cost the doctors and the hospital have discharged a person with inner ear balance problems and did not recommend nor prescribe a walker for M.  A walker that rents for $25/week.  They pay thousands of dollars a year for insurance in case of traumatic accidents.  But the health care industry does not recommend a $25 piece of equipment that could save hundreds of thousands of dollars of future cost. And possibly even prevent M's death from another fall.   A fall that is exponential more likely in the next few days.

There is a mindset in America that doctors are intelligent and knowledgable.  That they give us good health advice.  And that we should follow their "orders" - yet we don't need to use our own common sense.  M said to me that the doctor didn't prescribe a walker -- so she didn't need one.  I have to disagree with this mindset.  I do not feel that the doctor that discharged M was remotely knowledgable or intelligent about the health of M.  Nor was the hospital operating with the best interest of the patient in mind.  The likelihood of readmissions because of a poor post hospitalization care procedure is unknown to me.  The scientific community could know this information.  Yet they do not make it available or public.  This is the very reforms that are happening in the health care industry.  The Affordable Care Act seeks to reduce this type of treatment.


What does this have to do with software?  How is software development like or dislike the medical field?  Let's draw an analogy between the software release of an application and the release from the hospital of M.

If M were like an application that had just been released into production.  Then the risk that M may fall and be readmitted to the hospital could be equated to the risk that running the application in production may lead to some form of data corruption.  In software if and when this happens we label this event a BUG, and we suggest that we couldn't have been expected to foresee the bug - that it is just an accident and an accepted risk.  We may set up quality assurance procedure to mitigate the risk.  Yet we in the software industry are notoriously poor at mitigating risk.  Let's just look at the failed roll out of the Affordable Care Act web site.

The fact that this risk in the health care field most likely has some real actuarial data and analysis is something that the software industry doesn't have - may never have - and this is a shame.

If M were to fall and be readmitted to the hospital, would there be a case for malpractice?  I believe so -- but I'm no lawyer - and don't play one in the movies.  "You want answers?  I want the truth. You can't handle the truth."

The truth is M better look out for her own best interest.  The doctors are not using common sense to make obvious recommendation that save money -- but more importantly reduce risk of serious injury, pain and suffering.

In software we are not a profession -- we have no professional malfeasant liability.  Our mistakes and poor procedures cost our businesses billions, account for serious economic injury, and in some case damage political careers.  Yet we continue business as usual.  Never admitting to the incompetence that we secretly sweep under the carpets.


This makes me mad.  And it is hitting very close to home this week.  Both in work and in life -- as if those were separate.  They are not.  My personal life is reflecting my "professional" life this week.  I hope my work life doesn't get reflected in my personal life next week.  I hope M will get a walker.
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