In their 2010 book The Invisible Gorilla: And Other Ways Our Intuitions Deceive Us, co-authors Christopher Chabris and Daniel Simons, cognitive psychologists, “reveal the numerous ways that our intuitions can deceive us…” and “explain why we succumb to…everyday illusions,” according to their book's self-description on its book jacket. Chabris and Simons provide a fascinating look at how a lot of the mental processes we take for granted, under the dangerously broad umbrella of day-to-day intuition, are actually exercises in illusion and self-delusion. It's the kind of book that makes one question a lot of assumptions about how the human mind works.
Interestingly, the authors open their third chapter by relating a personal healthcare experience that Chabris had several years ago that left him “a little unnerved.” Suffering a lingering headache, body aches, and exhaustion, Chabris was initially diagnosed by a clinician at the university health service at Harvard University (where he was attending graduate school at the time) with some kind of flu-like virus, and told to go home and rest. When the symptoms persisted, and Chabris discovered a sunburst-shaped red rash on his left calf, he limped off to the school's after-hours clinic, where a physician there diagnosed Lyme disease, and prescribed a 21-day regimen of the antibiotic doxycycline for him.
Chabris writes that while the diagnosis of Lyme disease was unsettling, “even more unsettling was the doctor's open consultation of reference books during the session” (after informing him that he had Lyme disease, she had gone into another room to retrieve a medical reference book with information on its treatment). “Chris had never seen a doctor do this before, and this one did it twice. Did she know what she was doing?” Even as he rushed off to fill the prescription, Chabris questioned why a seemingly competent physician would turn to a reference work in his presence in order to prescribe treatment for a well-known disease. Ultimately, though, Chabris and Simons use the anecdote not to condemn this unnamed doctor, but to vindicate her, weaving together compelling, true stories and evidence in the literature that demonstrate that the more confident-appearing a person is, the more we believe them-sometimes with disastrous consequences.
In reality, the world is becoming more and more complex, and ultimately, more patients are coming to understand that, as the practice of medicine, too, becomes more complex and demanding, physicians will need to rely more and more extensively on clinical decision support at the point of care, on evidence-based order sets, and on other informational tools that can help them where they need it most-at the point of care or consultation.
And how can physicians most readily benefit from all the electronically based solutions out there in these areas? The easy phrase-as difficult as it is to execute-is just two words long: mobile computing. The question is, what do physicians want, and how-and where-do they want it? And what's possible?
As this month's cover story (p. 10) notes, medical group, hospital, and health system leaders are finding a very broad range of ways to meet physicians' needs for mobile computing, even as they work to balance out issues around cost, comprehensiveness, interoperability, user-friendliness, patient data privacy and security, and compliance with federal mandates, such as those emerging out of the HITECH Act and healthcare reform, going forward. Exactly how each patient care organization delivers mobility to its doctors will inevitably vary by individual organization; but the reality that mobile computing will soon be an assumed part of healthcare-well, that's just intuitive.
Mark Hagland, Editor-in-Chief Healthcare Informatics 2011 September;28(9):08
