Art and Science, Medicine and Technology – match them up

I once again found myself  discussing the differences between the viewpoint of a physician and a technologist. I’m speaking of a situation where both are well-educated and well experienced individuals. And given such a case, why is it that I continue to see physicians struggle with basic concepts in technology, and technologists failed to express their ideas and algorithms in terms that physicians would understand.

There is a very old saying that “medicine is more than art than a science”. I have heard this statement countless times throughout my years as a physician. The truth is that this is a nice way of saying that there are major holes in our knowledge base in medicine, and thus we are often left to make decisions based on personal opinion and experience. One can definitely question the accuracy of many medical studies. But nothing is as inaccurate as personal opinion and experience, despite the sermons on the mount by so many of the older group of physicians.

Effectively, when a doctor is hopefully honest enough to tell the patient that there is no evidence-based approach to their condition, the doctor also explains that he or she will make a decision that is hopefully correct. Depending on how the doctor interacts with the patient, the patient might accept this without hesitation. It is astounding how much trust patients will have in physicians, even those that they have limited experience with. Often, this trust has a close correlation to the approach of the doctor to the patient. If the physician has been considerate and kind and open to questions and honest with the patient, then the likelihood that the patient will accept the non-evidence approach, is high.

Needless to say, the hope in medical science is that we can reduce the art portion to the human connection. But when it comes to making a medical decision, that should always be based on the best data available.

When a CEO of the hospital hires a physician, he or she believes that physicians are fixed quantities. Medical education should be universal in style, format and content. Admittedly, there will be differences in the approach to explaining the histology of a cell or the relative anatomy of the heart to the esophagus. But once again for my own experience, these differences are likely subtle. It is true that my undergraduate professor in anatomy [who was a PhD but not an MD] taught anatomy far better than my medical school anatomy professor. Nevertheless, the content was the same. In fact, the book was the same. So when the CEO says that the hospital needs two more specialists in “X” and three more specialists in “Y”, the CEO counts on the fact that the medical school training and residency training of these physicians was standardized. While one of the physicians may have studied at Harvard and the other may have studied at Yale, the assumption is that both know the same information.

So despite the art component that still is a part of medicine, medicine is taught as a very structured, protocoled approach to treating patients. There is little in the way of personal opinion and innovation when it comes to treating a middle ear infection. There is an established protocol, which has been tested and proven multiple times, and thus every doctor should treat a middle ear infection in the same way.

When it comes to technology, one would think that there is little in the way of art involved. A person goes to school, learns how to program, learns how to extract data from a database and then how to present it on a webpage, and that’s it. Many think that if one person studies computer sciences at one school and another person studies computers at another school, basically they should have the same skill set.

I’ve encountered and read about many CEOs that assume that programmers and technologists are fixed quantities in the same way that physicians are. Ultimately, in the minds of these senior directors, it may even be purely a decision based on salary. So if one programmer is asking for 20,000 and a second programmer is asking for 30,000, then the decision seems very clear. Of course, you would hope that the CEO would understand that one needs to investigate why the second programmer feels he or she deserves so much more. But in order to appreciate the difference, human resources and the CEO would have to understand many subtleties that are related to software, hardware and systems development. And I think I’ve made it clear in previous posts, that this is definitely not the case.

In my previous place of employment, I had the great fortune of meeting and then hiring a young lady who was fresh out of her initial training period. It became clear very quickly that she was a brilliant programmer, who regularly thought outside the box. Over a short period of time she became the best colleague I could imagine. Her background did not include formal medical training. So, I would discuss with her issues related to writing software for physicians. She picked up on whatever I said immediately, and on her own, extrapolated to the next project. Over the course of the years I worked with her, we had two other programmers, experienced from previous work, who joined the team. They were both disappointments. They were not bad at their jobs. But they fell dramatically short of my young colleague.

I had heard other CIOs talk about individuals who could do the work of an entire department, and better. My colleague was one of those people. There is no question that if I had found one or two more like her, I would have begged  to have them come on board as well. The point is that while technology would seem to be a more exacting profession, in fact it requires a tremendous amount of imagination and an adventurous spirit. Unquestionably, a technologist whether a programmer or an engineer, needs to know how to use the available tools. But those tools are useless in the hands of a technologist who isn’t incredibly flexible and adaptable. In general, technology advances so quickly, that programmers will find themselves using tools that they never formally studied. How do they manage to do so? They play. They install the tool, play with the examples, look up information on the Internet, talk with colleagues and slowly but surely develop their own version of a set of tools that allow them to express their vision of the project they have been assigned.

So basically, the difference between hiring a physician and hiring a technology specialists is day and night. It is my experience and that of others I have read, that CEOs are far more comfortable hiring physicians, based on the assumptions I listed above. The when it comes to hiring an IT team, most CEOs really have no idea where to start and how to measure the quality of that team. This manifests as lost opportunities, wasted resources and generally speaking, failed projects. But even in the face of these failed projects, the CEOs might still not understand how one IT person can be so fundamentally different than another.

So medicine  strives to be a science, and technology embraces being an art. I have the astonishing luck to have lived in both worlds for over two decades. It has definitely been an adventure. And the insights I now have, are worth a great great deal to me.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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