The Velluvial Matrix

June 17th, 2010

Here’s one physician’s take on increasing complexity in medicine, given as a commencement speech at Stanford. I’ll let you jump over there if you want to find out the details about the “Velluvial matrix”, but it’s really just a device that lets him get at some big-picture ideas about the future of the field:

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

This reminds me a bit of the PhD comic, which shows how grad school makes you dumber (a phenomenon closely related to the Dunning–Kruger effect). The more we learn about physiology and medicine, the more specialized each branch has to become, and the more likely that we are to make mistakes when crossing disciplinary boundaries:

Smith told me that to this day he remains deeply grateful to the people who saved him. But they missed one small step. They forgot to give him the vaccines that every patient who has his spleen removed requires, vaccines against three bacteria that the spleen usually fights off. Maybe the surgeons thought the critical-care doctors were going to give the vaccines, and maybe the critical-care doctors thought the primary-care physician was going to give them, and maybe the primary-care physician thought the surgeons already had. Or maybe they all forgot. Whatever the case, two years later, Duane Smith was on a beach vacation when he picked up an ordinary strep infection. Because he hadn’t had those vaccines, the infection spread rapidly throughout his body. He survived—but it cost him all his fingers and all his toes. It was, as he summed it up in his note, the worst vacation ever.

This is absolutely relevant to my last post, about intelligent systems that can make decisions. If designed properly, a machine will never miss a piece of evidence or forget to perform a step. (that’s a big “if”, but one we need to start tackling). Studies have already shown that simple checklists can dramatically reduce complications and deaths during surgery. Now we need to be designing systems that produce those checklists instantly and adapt to the specifics of the patient on the table.

This isn’t as sexy as the type of personalized medicine that relies on genetic screening but it’s probably even more important, in terms of the capacity to save lives in the short-term.

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One Response to “The Velluvial Matrix”

  1. Very interesting. Our little start up ( hopes to reduce the complexity for physicians to make important decisions. The technology an platform is amenable to all sorts of scenarios so the physician will be in a “one stop shop” for deciding appropriate therapy.