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Curbside Consult with Dr. Jayne 2/17/14

February 17, 2014 Dr. Jayne 2 Comments

Across medical specialties, there’s a little bit of an “us vs. them” mentality when you look at physicians who use their minds more than their hands. We refer to it as cognitive specialties vs. procedural specialties. 

If you guessed that the proceduralists make more money, you’re right. Those of us on the cognitive side of the equation, which includes primary care, worry about keeping our minds sharp as much as surgeons worry about their hands.

Like cognitive physicians, many of us in health IT make a living with our brains and are under a great deal of stress. Sometimes it feels like we’re losing our minds when we have to try to figure out how to accomplish everything that needs to be done on limited budgets.

In doing psychiatry and neurology rotations, I always wondered whether people who are having brain disorders know that something is going wrong or whether things seem OK to them. When I feel unfocused, can’t sleep, and can’t concentrate, I wonder if something sinister is going on or if it’s just stress. I wonder too how many people realize I’m not on my “A Game” when that happens.

I’m excited about the potential for genomics and personalized medicine to be able to predict future illness on an individual basis. The idea of being able to prevent disease at the molecular level or to design targeted treatments after it already occurs is appealing. On the other hand, I’m not sure I’d want to know about conditions that might not be curable. It’s a double-edged sword.

It turns out that Big Data might be able to provide some advance warning at least for those of us who are writers. NPR recently re-ran a story from 2010 about an English professor at the University of Toronto who came up with an interesting way to bring literature and medicine together.

Ian Lancashire has been gathering Big Data on authors, looking at the number of words in their texts and the volume of usage. He tries to identify patterns that help him understand the author’s thought process.

Recently, he took on the work of Agatha Christie. He used computer analysis to review 16 books written over half a decade. He found that in one of her later novels, her word usage changed. The number of unique words decreased by 20 percent. Certain types of words increased in number. His conclusion: Alzheimer’s may have been responsible for the change.

He worked with others (including linguists, pathologists, and statistical experts) to review the work before publication. Although she was never diagnosed, she may have exhibited signs and symptoms of dementia by report. Interestingly, the book where the changes were noted is called Elephants Can Remember and is about a novelist experiencing memory loss.

According to the NPR piece, other Alzheimer’s research also indicates that patterns in writing can help identify those that may develop the disease. A study done with the School Sisters of Notre Dame looked at memory and aging. The sisters also allowed pathology review of brain samples after death. Researcher David Snowdon found writing samples (the sisters’ essays written when they joined the community) and analyzed them.

Those samples with higher “idea density” seemed to be less predictive of dementia than those with lower idea density. It certainly doesn’t prove a cause and effect relationship, but only an association. I wonder what it would look like if we did an analysis of the writings of the HIStalk team? How concordant would our “day job” work be with that written by our HIStalk personas? Would researchers be able to pick out those weeks when our real-world IT departments were crashing and burning around us? Could they identify the pieces we secretly wrote from the beach or other points unknown?

Some of the discussion after the broadcast centered on the large volume of digital communications that we now create each day. Could our employers mine our emails and instant messages to determine whether we are exhibiting symptoms of mental instability? Are we more depressed by failed projects and untenable initiatives than we should be? Does the level of anxiety among analysts predict whether one go live will be more successful than another?

Looking at my Sent Items folder, I’d be scared to have my work analyzed. It’s likely to show symptoms of multiple personality disorder as I have to play games with various providers to get them to comply with organizational initiatives. Throw in some crisis of identity with all the different hats I have to wear (often at the same time) and it could get really interesting.

What do you think your writing says about you? Email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. Cognitive medicine versus procedural medicine. A difference very few outside of the practice of medicine appreciate – with monster implications for IT and automation.

    I’ve always explained it as: procedural medicine you KNOW what the problem is and have a pretty good idea how to correct it (such as do surgery). Cognitive – you have some general idea what the problem may be but are not sure and have to fully ID it.

    To me that is why a good diagnostician is worth his/her wait in gold (see Dr, Welby or Dr. House) and surgeons are just good plumbers!

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