I have a long answer and a short one. The short one is that I believe that codifying medicine is killing the essence of medicine. William Osler coined the essence as: “Medicine is a science of uncertainty and an art of probability.” During the 50 years I have worked in hospitals all over the world, I always have enjoyed a good letter to amice. The last 20 years at best I had to accept sort of telegram style nonsensical referral letters, mostly the patient was transferred with one-word referral, like ‘headache’, ‘gallbladder’, ‘acute abdomen’. Often the single word had no close relationship to the patient or the complaint, without any mention of context. Dr Thornley just wrote a blog about the “Demise of Medicine”. It is a disaster waiting to happen?
Surprisingly so, I do like ontologies, because if designed well they represent at each step a question/decision/answer. The problem is the uncertainty we have to deal with. So, the idea of Diagnosis Related Imbursement of doctors is absurd, and yet everywhere in the world entertained by insurance companies and political parties. ICD10-11 is very popular for this purpose, even though it is designed for classifying causes of death, not daily practice. No surprise, in over 40% of death certificates, pathologists cannot relate the text in the certificates with reality, diagnostics in real live are even worse. Relating ICPC’s and ICD10-11 is impossible, and an example of the serious gap between the GP-bubbles and those of specialists. My conclusion for long is that we have developed natural language over 1000000 years, and 60 years of codifying has been a very nice experiment, which now kills the essence of medicine, the dealing with uncertainty.
The right diagnosis can be pinpointed in 80% of cases by good Medical History Taking. We need natural language for that and smart questions. This is how doctors (should) think, based on symptoms and signs the patient can report and show. That is called communication. The gathered data should be collected into a casebook with a pattern every doctor should have learned in medical school. In my own experience nowadays, visiting a doctor means an encounter a person who is glued to a square screen, does not introduce 'it’self, and often turns out to be a nurse or aid. NIH informs patients that a large part of medical care is provided by nurses. In the UK this has been ‘codyfied’.
As an anesthesiologist I deal with easy work, which if it goes wrong has serious consequences. This is the typical business model for insurance revenues, dealing with incidents with high impact. That has triggered me into my quest for intelligent, smart and efficient medicine. IT has a lot to offer, because smart, intelligent and dynamic questionnaires are able to extract very useful data from patients, and those data can be translated into structured and patterned information doctors like. This is the essence of my current work, MediPrepare Open Source Project. Every doctor now could create Expert Medical Systems with our tools by creating questionnaires for all 130+ specialties and incorporate their expert knowledge. The data can be translated into valuable information leading up to a differential diagnostic path which can be started by the patient.
So, I believe that using the route of natural language in Medicine for many years to come will be superior to communicating in digitized codes. Eventually smart computers will be able to dissect our natural language to the point that we can let them communicate by digits. For now Codifying Medicine is killing patients and doctors. In the USA third cause of death is medical mishaps… Maybe we need meaningful IT, created by close cooperation of doctor and programmer, like was used in the Caduceus Project at Pittsburgh University Hospitals around 1980.
My 5 cents, Hans