Andrew Gunn – (we)blog therefore?

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-voodoo-medicine
The Last Word: on voodoo medicine  19 July 2013

Could computers do the work of GPs? Australian Doctor recently raised this question (14 May 2013), and, last week, a medical student asked me a question that I’d like to hear a computer answer: “What do GPs do?”

My reply was: “Voodoo.”

This wasn’t an attempt to belittle either general practice or voodoo. It’s just that most of the stuff we do isn’t particularly scientific. Well, most of the stuff I do isn’t. A Cancer Council CEO once accused me of being so unscientific that I would have been against electricity — or, as a friend calls it, “electrickery”.

For instance, on completion of a home visit this week, I gave a sick 91-year-old woman a quick peck on the cheek.

I recklessly did this despite my profound ignorance of randomised controlled trials on this intervention in this patient cohort.

AHPRA probably won’t hear about it. My patient doesn’t speak English and, more importantly, she was delighted. Her carer quietly commented that no medication could be so helpful. A stint in palliative care taught me the therapeutic power of a handshake and smile, regardless of a patient’s condition and smell. In fact, the worse the patient’s condition and smell, the better it works.

Here’s more evidence that I practise voodoo: computers are awesome at doing K10s, depression scores, pain scales and all that stuff. But I viscerally detest the lot.

This might be genetic. My octogenarian mother recently had a tense argument with a nurse.

The nurse wanted to record a pain rating number but my mum insisted a pain scale was relative, not absolute, so she might as well just tell the nurse if the pain stayed the same, got better or got worse. The nurse lost because my mum’s blood pressure skyrocketed.

A Prevocation General Practice Placements Program resident asked me last week what questionnaire I use to diagnose depression. I silently reflected on the science behind putting antidepressants in the tap water.

Then I said that I’m an analogue, not digital, doctor. I diagnose depression when patients are saddening, mania when they’re fun, schizophrenia when they’re interesting, borderline personality disorder when they’re irritating and psychosomatic illness when they’re angrily denying that their symptoms could have any psychological component.

If greater diagnostic or therapeutic effect is required, I dance around rattling my skull stick or stethoscope — whichever first comes to hand.

The 1791 Haitian Revolution apparently began with a voodoo ceremony.

White folks in the southern US were frightened their slaves might get similarly uppity ideas. Uppity blacks also had grounds to be frightened. A participant in the 1811 Louisiana slave revolt “had his hands chopped off, then shot in one thigh and then the other until they were broken, then shot in the body, and before he had expired was put into a bundle of straw and roasted”. Voodoo has never been the scariest thing in Louisiana.

Voodoo dolls are usually used to bless people, not to hex them, yet the connotations of voodoo are invariably bad. For instance, the term ‘voodoo economics’ is self-evidently derisive.

As it happens, voodoo economics — that’s the supply-side, trickle-down variety — is the opposite of voodoo. Like most religions, voodoo teaches that greed is bad and generosity is good although, for some reason, the walking dead and eating flesh are less creepy when labelled as the Resurrection and the Eucharist.

So, could computers do the work of GPs? I don’t think they’ll replace us anytime soon but I am making a small straw computer. I could do with a pincushion.