A Point to Ponder

I recently came across reports about the final minutes of Air France Flight 447, which crashed into the Atlantic on May 31, 2009, while traveling from Rio de Janeiro to Paris. All 228 on board were killed.

Investigators have determined that a few minutes before the fatal crash the cockpit crew received repeated stall warnings and fluctuating airspeed indications. In the confusion, they made a fundamental error by yanking the nose of the plane up, even though Air France procedures and the most basic pilot training tells pilots to point the nose down during a stall to gain speed.

Aviation experts quoted in a Wall Street Journal article predict the accident will result in a shake-up of pilot training over concerns pilots have abdicated too much responsibility to computer aids and, when those aids malfunction, can't handle emergencies because of rusty piloting skills.

"Pilots are starting to serve the automation, not the automation serving the pilots," Bill Voss, president of the Flight Safety Foundation, told the Journal. "It's almost like we have to train the pilots to know how to triage the situation."

Not sure anyone would argue the health care industry is in any immediate danger of being over-automated, but the question of whether automation serves the user, or vice versa, is an important one. Industry gurus typically point to aviation as a model for medical reform, and there is absolutely no question that automation has increased aviation safety. But automation shouldn't lead us to a point where a pilot stops being a "real" pilot, or a clinician a "real" clinician.

There is a critical gap here that needs to be addressed before true symmetry is achieved between man and machine. Clinicians on the sharp end of patient care face situations where the computer is telling them one thing, but their eyes and experience are telling them another. Medical and nursing schools are making concerted and expensive efforts to get their students immersed in I.T. the minute they enter a program. Which is a good thing, as long as the technology is in support of their training, not the purpose of it.

Something to ponder as health I.T. catapults the industry into a new and vastly different practice of medicine. Technology is designed to help clinicians be the best they can be, but it can't make a bad clinician a good one.

Medicine is, and should be, more science than art. But let's not discount what that art comprises-a mix of wisdom, experience, empathy and intuition that can't be taught to information systems.

Greg Gillespie

Editor-in-Chief