Without a doubt. It is Monday morning. My mood is quite below temperature as I try to put the rigid wheels of the ‘hypermodern’ cow (computer on wheels) towards the hallway. Two surgical interns follow me like young ducklings in a pond. It is time for a daily ritual doctors have been practising for centuries: rounds. Anyone who ever attended one or happened to be the patient; you know what I mean. A white wind of medical personnel talking about you in words that might well be Russian or Chinese. For all parties, not in the least the patient, this ritual can be quite uneasy. As if you were a rare creature in the wild, the group gathers around you. This feeling of inappropriate voyeurism is also felt by those wearing the white. And in an age of safe and distant digitalisation, young doctors tend to seek comfort behing the safe computer screen. On this screen, the patient is a clean and emotionless collection of data. No unexpected questions, no tears or other body fluids. However, this ‘unnatural’ round of dialogues, remains one of the cornerstones of good health care.
Before we enter the room, I face the interns. It is their first day. They look at me wandering if I will be wat they expect of surgery. “You don’t know the patients in this room. Your first reflex will be to grab a computer, if you haven’t done so already, and to gather as much information in order to think you can limit the chances of not knowing. But please, I only ask one thing of you today. Look at the patient not as a doctor in training, but as a biologist.” Their state of confusion is visibly increasing. “Don’t diagnose, just observe.” Like my hero sir Arthur Conan Doyle, writer of the stories of Sherlock Holmes, would state: “It is a capital mistake to theorise before you have all the evidence.” We enter the room and walk towards the bed of an old man who has many tubes surrounding hem that he might well be a Christmas tree.
For centuries, medicine has been a job making ultimate use of the senses. Observation was a way to understand and treat the suffering of others, long before we understood the mechanics of the heart or the liver. We looked, listened, smelled and felt. The famous peewatchers held the urine production of a patient high in the sky to diagnose the origin of pain or sickness; they even tasted it. Diabetes mellitus literally means ‘sweet pee’, caused by the glucose that the body has not absorbed and is thus excreted. Red urine often contains blood caused by kidney stones that caused damage to our renal tubes. And these are only a few examples.
While my colleague is talking to the patient, I stand back and ask the interns: “What do you see?” Quietly the first utters: “But uhm, what can we see if we don’t know what his diagnose is?” I wait and look at the other intern. “What do you see?” She turns to the patient and whispers: “A pole with a bag of fluids?” “Indeed”, I answer, “Very good.” “What does it contain and where is it going?” The other intern walks closer to the pole and reads the name of the antibiotic written on the bag. “Might he have an infection?” What else do you see?” The wall behind is bed is full of postcards. “Maybe he has been here for a long time; but he also has a lot people that care about him.” I smile. On the little table next to his bed lie an insulin pen and a book about birds. At the side of his bed a big bag with yellow fluid can be spotted. The interns look at me, surprised by the amount of information the could deduce only by means of observation.
Once a week we have a so called grand round. It is amazing to follow the footsteps of an ‘old doctor’. His eyes, his ears, his nose and his fingers have experienced so much that he walks the ward as an old hunter in the Amazon rain forest. He can tell the honey like smell produced by pseudomonas bacteria in a wound and hears the unbalanced pace of a patient suffering from a difference in leg length after an operation.
Might it be a romantic mistake to rely too much on our senses? The 21st century is characterised by increasing evidence illustrating that our senses can be tricked and lead to irrational and wrong decisions. Daniel Kahneman and many others warn us to think slow carefully. Might we be better of te leave the diagnosis of abdominal pain to an algorithm?
As a young surgical resident, I might underestimate the power of artificial intelligence because it might take over my job one day. However, I also feel that doctors are little algorithms themselves. Our senses our amazing wearables that can learn and adapt. Even more so, our capacities to integrate the information of different senses is a product of decades of human evolution. So, if you are sitting at a cosy Christmas dinner the coming days and you get involved in medical discussion. Before you swipe or ask Google, try your own senses for a change. They might surprise you.
