Tuesday, January 10, 2012

Dammit Jim! I’m a Doctor, Not an Engineer

Happy New Year from the Singing Pen.   I'd like to kick off the 2012 blogging year with a guest post by my father, Mr. Victor Middleton, who is, in fact, an engineer....

Dr. Jen, a Star Trek fan, has been known to quote Dr. McCoy’s dictum (lament or boast depending on your point of view) to her brother James whenever she requires assistance with recalcitrant computers. I am an engineer, and I find this plaint typical of the gulf between our respective professions. Doctors tend to view us as overseers of useful but often-wayward tools.  Doctors practice the art of medicine; engineers are mechanics who help take care of support details.

I’m writing this piece to try and modify that point of view and to urge a closer interaction between medicine and my particular flavor of engineering.  What I do can be classified as systems engineering or industrial engineering, or, as I prefer, operations research (OR) engineering.  

OR practitioners are dedicated to improving the operation of systems of all sorts, whether they are organizational practices and procedures, manual processes, mechanical controls and devices, computer software, or combinations of all of these.  OR as a discipline traces its origins back to World War II when engineers and mathematicians were asked to help optimize resources, including personnel and materiel, for maximum military effect. OR groups attached to the British Anti-Aircraft Command were charged with the improvement in deployment and use of Britain’s new radar network and helped win the Battle of Britain; similar groups developed novel submarine search and engagement procedures to defeat German U-boats in the North Atlantic.

The key phrase above is the “optimize resources, including personnel and materiel.”  It is incontrovertible that the health care system in the US today needs to do a much better job with respect to utilization of resources on virtually all fronts, from matters of national policy to local hospitals and health care providers.  We OR engineers can help.  

Even a cursory Internet search on health care and operations research will display a wide spectrum of ways in which OR can help docs and other health care providers, saving money through more efficient operation, but, more importantly, helping to optimize patient health care outcomes.  It would be futile for me to try to describe the extent of OR applications to health care here, but I would like to mention a few overarching principles. 

First, OR is a systems science that seeks to integrate local capabilities into more global solutions.  How do emergency room practices affect operating room availability?  How does scheduling for elective procedures affect overall hospital bed occupancy?  How must vaccination and treatment protocols be adjusted to deal with the differences between local disease outbreaks and the potential for deliberate terrorist attack?  Perhaps the best example for Dr. Jen and her colleagues would be: how does the family practice doctor help coordinate general health issues with specialist care?

Next, OR and industrial engineering seek to look at the role of systems in preventing errors.  The medical profession tends to view error as attributable to mistakes by individual practitioners.  Since we have as yet been unsuccessful in developing fail-proof individuals, a far more fruitful ground for eliminating errors is developing systems that first help avoid errors and that help identify them and mitigate them when they do occur.  Such a systems approach encompasses everything from human factors design of automated data entry and retrieval, to computer diagnostic aids, to more efficient training and re-training, and to the development of redundant procedures that check and double-check the appropriateness of treatment.

Finally, I would like to note that as engineers we share an ethical bond with physicians and their mandate: “Primum non nocere.”  As engineers, we are not impartial scientists objectively studying natural phenomena to see what makes the world tick.  Our job is to make changes to that world, and thus our ethical responsibility is to ensure that we change it for the better.  I can think of no better way to meet this responsibility than joining with medical community to address the health care needs of our country and each individual in it.

Interested readers are urged to search the Internet.  A small sample includes:
(This last, while strictly speaking not OR, certainly expresses an OR perspective on the problems with the health care system in the U.S.)

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