This is the 164th #WILTW

I came close to starting this piece by making a fundamental error. I was going to discuss how the ‘case’ of Charlie Gard is a tragedy. A tragedy it is, but to describe it as a case does no justice to anyone involved in this heartbreaking situation.

It is events like this that demonstrate the fragility of social media as a communication mechanism. All sides involved, most importantly the  parents, but also the professionals (medical and legal), organisations and national bodies passionately believe in Charlie’s best interests. There are no monsters. There is sadly a lack of humanity, not from those who are involved, but from those who feel they have a right to judge, berate and decide what’s best for a situation in which few can comprehend the moral and ethical dilemmas at play.

In a completely unrelated, but actually quite relevant, BMJ blog this week Dr. Matt Morgan challenges the way we currently examine doctors in medicine:

Although undergraduate training has adapted to some of these changes, the postgraduate world needs to embrace the changing roles and skills needed by medical professionals of the next century.

Many of the current processes of testing competence rely on the doctor making the correct diagnostic decisions. But testing pure factual knowledge and clinical examination has been recognised as a poor surrogate for future clinician performance. To be fair, examinations necessary to become a Consultant or General Practitioner almost certainly also include complex cases involving ethics or challenging communication. But Dr. Morgan I think correctly highlights the difference between being able to answer difficult questions about a case, and being able to ask the right questions about a difficult case.

He identifies while it is almost certain the use of artificial intelligence in medicine will grow, it is difficult (currently) to see how a data led approach to diagnosis can deal with grey medicine.

The challenge, increasingly, is to understand:

Not, what is the definitive cause of a symptom but what definitely isn’t the cause of it…?¹

Not, how do I treat this, but should I…?

Not what are the consequences of my decision now, but what might they be in the future…?

While ever cleverer computer algorithms, imaging devices and cutting edge diagnostic technologies will improve processes in medicine we must ensure that our underlying principles of practice remain true.

I am certain the doctors and nurses caring for Charlie Gard have used every tool at their disposal to investigate and treat him. I am also sure they have been equally diligent in exploring all the ethical and moral dilemmas exposed. To not do so would be leaving medicine in the hands of computer programmes which may well reduce patients to ‘cases’ to treat rather than people to care for.

What have you learning this week? #WILTW

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1. This topic was explored in “If you know what its not, is it ok to not know what it is?“