The Angel in While Was a Competent Mathematician

One day I opened the web site of a local bank to check my account balance to find an advertisement that amused me. It read:

Banks should only treat you like a number if your mum named you "00-1247-6578-000."

Similarly I have heard a radio advertisement of personalised car licence number plates which goes like this:

If you don't call the dog you love "BCD345", why do that with your car?

Then what do you expect from nurse stereotype as "an angel in white" with regard to treating her client? It would be far from treating you like a number, wouldn't it?

Surely so was the original "the Angel in White", Florence Nightingale in the legendary service in the Crimean War but actually she was also a competent mathematician.

Sun Tzu said, "Many calculations lead to victory, and few calculations to defeat."

Her approach to patient care was based on statistical evidence and she was more a strategist than a tactician as an epidemiologist. So her victory was brought by many calculations as well as her dedication.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

If Sun Tzu was around Today, He would be a Promoter of Immunisation Programmes

Although the medical and scientific evidence suggests that the benefits of preventing suffering and death from infectious diseases outweigh rare adverse effects of immunization, governments around world are struggling to roll out immunisation programmes effectively.

Anti-vaccination movements in some countries have been so strong enough to jeopardise not only the specific immunisation programmes but also the whole research and development activities. Sadly my home country, Japan is one of the most significant in this regard, considering the potential contributions in this particular field which otherwise should be made by the country.

Many critics are from the fields of natural and/or holistic medicines mostly based on traditional wisdom. I think the very idea of inducing a cunning enemy itself, even after converted or neutralised, into our bodies to fight against its former friends contradicts our intuitive knowledge.

However, one of the best known traditional wisdom may be fully supportive to immunisation programmes.

Sun Tzu said, "The enemy's spies who have come to spy on us must be sought out, tempted with bribes, led away and comfortably housed. Thus they will become converted spies and available for our services."

When I hit upon the idea that healthcare as warfare against health problems is also based on deception, this phase came upon and I realised that immunisation was taking the same steps.

We identify the infectious agents, cultivate them as they are isolated and contained. Finally they are made into or used to create immunisation agents which are available for our immunisation services.

So if Sun Tzu was around today, I would not surprise seeing him to act as a profound promoter of immunisation programmes.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

What you mean by Diagnosis

Sun Tzu said, "If you know the enemy and know yourself, you need not fear the result of a hundred battles."

This is a very famous saying and probably you have already heard about in some forms.

The same applies to outcome of medical treatment. What matters is whether the diagnosis is right or not. The word diagnosis comes from Greeks, dia- (through, complete) and gnosis (knowledge).

Once the right diagnosis is made, it means complete knowledge of the enemy (disease and related condition) and yourself (various constraints on medical practices) is available. Then you need not fear the result.

Sun Tzu said, "If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle."

Let's hope next time we receive a diagnosis, that it actually means "complete knowledge."

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

Can you win all of your battles?

Sun Tzu said, "To fight and conquer in all your battles is not supreme excellence; supreme excellence consists in breaking the enemy's resistance without fighting."

We boast of miracles that modern medicine made possible but these miracles require victims of predicaments to be cured in the first place. It would be better if these conditions do not happen at all.

As we discussed earlier, healthcare is warfare, and based on deception, it is the best if we do not need to mobilise its forces. Particularly any invasive interventions are to be avoided or minimised where possible.

Being healthy without any professional care is, no matter how unachievable it would be, the ideal. Then Sun Tzu also told us, the way to get closer to this ideal.

Sun Tzu said, "The good fighters of old first put themselves beyond the possibility of defeat, and then waited for an opportunity of defeating the enemy."

As though Sun Tzu foresaw recent emphasis on preventative medicine. The better you prepared to fight, the less you actually forced to. You would ultimately be able to defeat or subdue the enemy without any fighting.

Si Vis Pacem, Para Bellum - If you wish for peace, prepare for war. But it is not about piling up weapons but about elaborating strategies.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

All warfare is based on deception, so is healthcare

Sun Tzu said, "All warfare is based on deception." If it is followed by "So is healthcare." you would not believe it.

As you would not be buying medical paternalism which was so dominant in earlier times, you may argue against it by pointing recent emphasis on informed consent, patient/customer satisfaction, self-control and medical ethics.

But I think this notion is still quite relevant especially in terms of professional healthcare services. However the point is what should be actually deceived.

Of course, the health practitioner and the patient/customer should build mutual understanding to achieve the best results so this is not the case. Then how about their common enemies? Undesirable health conditions and the causes of them are what we should deal with deception.

Why with deception? Because when professional interventions are called for specific health conditions, they are already beyond human's natural coping mechanisms against physical, mental and social conditions. We have to deceive the agents causing implications to neutralise them and we also have to deceive our own defence responses against them to prevent overreaction or to revert irresponsiveness.

In fact, all medical interventions are outright criminal acts if administered by a person without credentials.

Like the enemy we fight against in war, the cause of our health problems are merciless to us. So we fight against them based on deception.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

New Year's Resolution

Just a few posts in last year, I would write much more often this year.

My Quest for the Holy Grail of Health Informatics has been not easy, but showing some progresses. However, there are some difficulties in writing these developing stories as blog posts, so I will take a bit different approach in this blog from now on.

Have you ever heard of Sun Tzu's 'The Art of War'? I recently read through it and watched a TV programme on History Channel featuring this ancient wisdom. I was really impressed by its comprehensiveness and relevance for over 2,400 years and even today, with regard to winning over merciless enemies.

Healthcare is literally 'a matter of life and death' as Sun Tzu perceived the art of war. In fact, it is a war we cannot afford to lose and 'a road either to safety or ruin' not only for a person but also for a nation.

As Sun Tzu dedicated a whole chapter to the intelligence, it is of crucial importance in healthcare, too. Health Informatics is what it is all about.

So I would like to discuss applications of the principles from 'The Art of War' into Health Informatics and/or Healthcare itself here. I am already brimming with ideas on the excerpts to put here. I hope you enjoy them, too.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

It's Not a Pulp Fiction: Never Underestimate the Power of Paper

This year I had a several chances to visit medical/dental clinics for check-ups.

My home doctor and dentist are using fully electronic medical/dental record systems (EMR/EDR), so my records are kept electronically and virtually nothing on paper. Even an X-ray image has been sent online. As a result, I don't have to carry a large brown envelope containing my records with a referral letter.

No wonder New Zealand ranks among top countries for primary care electronic health record adaptation. Then, are they paperless systems? No, I have whole lots of pieces of paper they printed out. Mainly bills and receipts and appointments. Maybe they could be substituted by email notifications. But I can bet I would be printing them out instead.

Once I really tried hard to get along without any paper at my work as health IT analyst. I felt obliged to do so as I was advocating "paperless" systems. But I had to throw away that practice eventually. It was just not practical. So I would never recommend it to health practitioners especially if they are to take care of me!

The power of paper should never be underestimated. It is said that we are using more paper than ever as IT adaptation become dominant. It quite matches my own observation. Actually the more IT advances the more useful and attractive its paper output becomes. So it gets just more and more irresistible.

Frankly speaking, in healthcare settings, physical cost of paper (and ink) is negligible compared with other significant resources. If a pack of paper can make difference in a life-and-death situation who cares its cost? What actually matter and should be reduced are the operational costs and potential errors in handling paper, not paper itself.

So I would like to propose a more accurate phrase to represent our practical goal: Paperwork-less EMR systems.