Internal Medicine is a Wicked Problem – implications

Currently listening to RANGE: Why Generalists Triumph in a Specialized World by David Epstein. In the first chapter he discusses the differences between wicked problems and kind problems. For example, chess is a kind problem. It has specified rules and clear outcomes. Because it is a kind problem, AI can successfully play the game. Wicked problems do not have rules or even a single known solution. One cannot always determine outcomes because we have many variables and many dimensions to the outcomes. Internists face wicked problems regularly. Many of us chose internal medicine because we love the challenge of these wicked problems. Diagnosis is a classic wicked problem. We deal with a large variety of inputs and are not restricted to one clear answer. Some patients have more than one diagnosis explaining their symptoms. Often performance measures, experts and guidelines treat testing or management decisions as if they were kind problems. But clinicians quickly understand that each decision has nuances based upon the patient’s complexity. Even Evidence Based Medicine can suffer because the evidence base does not really fit the patient we are considering. And that is the problem we confront. We want to measure quality, yet we are facing a wicked game. With some literary stretching, consider that once famous song “Wicked Game” by Chris Isaak – “What a wicked game you played to make me feel this way”. While he is talking about love,...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs