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Views of a Hybrid: clinician and informatician

Picture of surgeonSimon Dodds is a Consultant Vascular Surgeon. He refers to the debate reported in this FHIT entry. I am posting this extract from an email he sent me with his permission.

With my clinical head on I rant about the informaticians that never actually come and see what frontline healthcare delivery entails, never experience for themselves what the problems are, or help tease out the information requirements from the rest of the process (i.e. write the information requirement specification), then offer simple, workable, quick, cheap options based on existing technology, then help choose the most viable options, then quickly design and build prototypes that are usable, then test options and find those that actually work better than what we were doing before, then implement the best seamlessly so we never really even notice it's there (until it goes away and we suddenly realise we can't do without it).

All I get is: "You are not allowed to do anything with IT because you are not to be trusted." Or: "If you can't write the requirement spec. then we can't help you." Or: "You'll have to wait until the National Programme [NHS National Programme for IT] delivers the solution". Bit of a gulf there ...

With my computer scientist head on I rant about the clinicians whose thinking is so ossified that their resistance to change is a dangerous obstacle to improving patient care, that just don't seem to be aware that the world outside their little empire is changing really fast and this change is bringing lots of opportunities for improving things with well designed application of IT, that their combined arrogance and ignorance (of IT) has reached a dangerous degree that they would do anything rather than admit that they might not know something, that behave as if their prime directive is to do as much private practice as possible and don't appear to have the patients' needs and opinions in mind at all (though they'll never say that openly).

What I need are clinicians who start from a shared principle of delivering the highest quality care possible, who are prepared to question the way they think and work along with everything else involved in delivering healthcare, who are prepared to change the things that will lead to improvement and keep the things that are working well, who are prepared to help specify options and test ideas, who are prepared to offer constructive feedback, and who are prepared to learn enough about the principles of IT development and implementation to understand the pressures and constraints that I am under. Bit of a gulf there too ...

I have deliberately overstated the case but the scenario is not fictional ... what is clear is that both scenarios are the actually the same scenario ... they are the classic conflict that arises from separate paradigms of the same problem .... but the wood is lost for the trees .... the conflict is all man-made and arises from lack of an explicit shared understanding of the actual goals - the protagonists are in heated agreement.

This is not a win-lose game: at the moment both are losing. With my two heads I see no conflict because I understand both points of view and can therefore drive the innovation to meet both needs: the win-win option.

In the debate I could have argued either side with exactly the same argument and the way the voting would go would depend entirely on the mix of paradigm and prior experience of the audience and nothing to do with what we said because we weren't addressing the underlying issues—though there were a few glimmers of insight appearing.

Until clinicians and informaticians start to address their collective ignorance of the age old principles behind the successful management of change, the sterile debate will continue. Both camps will continue to be unhappy but won't really understand why, disappointment will be inevitable, money will be wasted, and resistance to change will increase further, the "burned out" will jump, the inexperienced will make all the same mistakes again, and round we go .... thus it has ever been ...

Have a look at my website www.simondodds.com. The book "Three Wins ..." is the story of the telemedicine project ... it has been described as a "potted change manual" and I'd be interested to hear your views as an experienced informatician and innovator.


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It is perhaps less surprising that Mr Dodds is an innovator:insight often comes from being able to see an old problem in a new light. This is closely linked to his dual competencies as surgeon/computer scientist.

It is rare for medics to be able to see a problem from the engineering/business angle. Medical training provides only limited exposure to alternative ways of working and schools of thought. It is perhaps unsurprising there is more clinical IT innovation in the US, where medicine is a post grad subject and it is less unusual for doctors to have a BS in computer science, an engineering discipline or possess a business qualification...

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