Fog of war in healthcare
A Fog of war is a military term for the uncertainty of war. First used in 1832 by a Prussian military analyst Carl von Clausewitz.
“War is the realm of uncertainty; three quarters of the factors on which action in war is based are wrapped in a fog of greater or lesser uncertainty. A sensitive and discriminating judgment is called for; a skilled intelligence to scent out the truth.” — Carl von Clausewitz, 1832
What relevance does that “war term” have to primary care and healthcare in general? Well, actually a lot. The human body is a complex system, which is still only roughly understood.
Just to underpin the point — according to a recent study: https://www.sciencemag.org/news/2020/10/you-may-have-new-organ-lurking-middle-your-head
Meaning, even in the best of cases our health condition reside in a form of uncertainty — to a lesser or greater degree, depending on the quality and accessibility of the data your doctor collect on your health.
So what’s the problem? Well, the problem appears to be — in Denmark and perhaps the US — that relevant health data is hardly collected, made accessible and actionable to all relevant parties before or even after diagnosis. The underlying reasons for this differ depending on the region.
In Denmark, there are at least three problems that leave patients health condition in a state of greater uncertainty than necessary:
1.Doctors in primary care are too pressed for time. So much so, that they rarely have more than a superficial insight into most of their patient’s health. They often have to rely on patient self-reporting. Which means that the patients themselves have to identify — if they have health issues that need their doctor’s attention, guidance and or treatment.
This approach moves the responsibility of action over into the hands of the patient and away from the health professional — it is worth mentioning this is not on purpose.
For the most part — the patient has no health expertise whatsoever or the ability to discern what is serious or what is nothing to worry about. This is a serious problem in itself — but there is more.
2. Doctors are diagnosing with too little good data. When a patient reports a problem that seem simple — they are often prescribed a quick solution. A solution based on the following data points — please note this is from a patient perspective:
+ The given symptom or symptoms.
+ ID, name, age, sex and height
+ a visual observation on how well the patient looks and behaves.
+ perhaps medical history (Often limited and without context)
+ perhaps a check for a specific problem, with followup questions and tests.
If the issue disappears or is solved by the given solution, the doctor and the system would deem the patient to be healthy and well. At least in Denmark.
This would on the surface be efficient. Yet at that very same instant, the patient might have several underlying health issues, unknown to both doctor and patient.
Why? Well, like I mentioned earlier this approach relies on patient self-reporting and add to that a stressed-out doctor, with too little time.
What is often left unknown and superficially explored, is the patients actual health condition. Like how is the state of the patients body. What state is the organ-systems in, such as the cardiovascular-, respiratory- and muscular system.
Meaning most patients health condition reside mostly in a greater deal of uncertainty — even after your doctor have cleared your health.
This kind of uncertainty might, in particular, be an issue in Denmark, but since WHO have reported that ´80% of premature heart disease, stroke and diabetes can be prevented` and a study published in BMJ found that “…diagnostic errors affect at least 1 in 20 US adults.”. It might be a transnational problem.
3. Poor patient journaling. Patients that are sent between several specialists, face a special kind of uncertainty problem. They have to report their symptoms with consistency, relevant updates/changes and their medical history if relevant on their own — to each new health professional they are put in contact with.
While there does exist records with each health professional, they are disjointed and don’t seem to assist the patient or even the health professionals with the most basic record keeping with regards to what ails the patient.
Data is lost as patients are left with the responsibility of keeping track of vital information, but with the tools to do so.
It is worth mentioning — there often exist relevant data somewhere in the system, but the patient does not have access to it in a form, that makes it useful.
From what I have learnt this might again be a transnational problem, where health providers act as independent data silos that keeps relevant data isolated from other health providers and the patient. Reasons for this differ and deserves its own article, with more research.
Conclusion
So is it all doom, gloom and uncertainty? No, we just need to accept that our health condition at the outset is in a fog of war, that need to be diminished as much as possible — and as early as possible.
We need to empower every individual with the ability to track their own general health condition and symptoms in an intelligent personal health profile. So the individual knows exactly what works. What should be fixed — and what their doctors believe they should do to stay healthy, become healthy or get well.
On top of that patients should in their engagement with healthcare automatically generate a useful health record.
Doctors should have better tools, that help them identify what they know about their patient’s health — and make it easier for them to collaborate with their patients and other health providers.
Ideally doctors should in partnership with their patients have an instant overview of the physical state of the patient down to every organ system. So when the patient suffers from a symptom, the symptoms are put in the right data context. If there are no data on fx. the cardiovascular system, then the doctor should retrieve the information, with the most efficient and least intrusive method. If the health data is critically outdated, then the doctor should get it updated.
In my eyes, this could alleviate some of the fog of war within primary care and healthcare in general, at least in Denmark🤔
If you think, I am on to something please leave a comment, share and let us connect.
And if you want access to a solution, that tries to fix some of the issues with “the fog of war” in healthcare — then sign up for Atmos.
Atmos is an early-stage startup project that attempts at making it easier to track and follow up on multiple health issues independently or in collaboration with your doctor.
