A Focus On: The Computer and the Clinician
William Herschel discussing astronomical developments with Charles Babbage, as shown in the Oxford Handbook of Clinical Medicine, 8e. Herschel looked beyond his data to understand what it was he was seeing; the OHCM draws this analogy: “Many clinical signs have yet to be described. Keep looking. Sometimes a star is born (and whenever one is, it will be found to be made of familiar elements: precision, analogy, imagination, and curiosity).” From History and Examination. In: Oxford Handbook of Clinical Medicine, 8e. Longmore M, Wilkinson IB, Davidson EH, Foulkes A and Mafi AR. Publisher: Oxford University Press.
DOI: 10.1093/med/9780199232178.003.0002. © OUP 2010.
It is of the highest importance in the art of detection to be able to recognize, out of a number of facts, which are incidental and which are vital. - Sherlock Holmes, The Adventure of the Reigate Squire
The digital world has fundamentally changed most aspects of our lives, especially in our communication and access to information. In medicine, technology even mimics the way we think, as complex databases have become an essential part of clinical practice. So with the emergence of these digital tools, will the thinking clinician go the way of the dinosaur? Will computers replace clinicians? Hopefully not.
In order to make progress with genomic databases and human disease, it is essential to compile accurate phenotypic and natural history descriptions based on descriptions and distinctions from experienced clinicians. There remains a need for the so-called “Art of Medicine”, which includes assessing the patient and the problem at hand, then providing the right information—at the right time, in the right way—to the patient and family in order to achieve optimum health outcomes.
Part of this “art” of medicine is recognizing our limitations. Experienced clinicians have seen a wide range of variation (although probably not all of it), including both the rare and the complex. But just as they are usually quite aware of (and humbled by) their own limitations, a computer is designed to be exact—to be definitive. While digital databases are essential to the modern clinician, they have their limitations, just like human clinicians.
As a clinician interested in congenital anomalies and physical measurements, I can attest that clinical exceptions always exist, even with the best data available. So with that in mind, it’s important to derive the most important considerations, then amalgamate them with the available data and standards to arrive at a rational diagnosis. I call this “clinical judgment,” and it’s still what is needed.
Judith G. Hall, OC, MD, Professor Emerita, Departments of Pediatrics and Medical Genetics, University of British Columbia
Oxford Medicine Online contains a wealth of content relevant to those working in this field, and with new content recently added, now contains over 1,100 chapters of genetics-related content. This coverage takes in many perspectives, from the student to the specialist.