role of diagnostic in professional

Role of the Diagnostic in Professional Practice - medicine vs law

Triggered by some comments from Prem Chandavarkar, my last post

discussed the development of a discipline of practice. Here I defined

one knowledge domain as the application of the profession in practice

by individual professionals. Doctor/patient, lawyer/client etc.

Essentially, how do we do what we do.

I thought that I would extend this discussion by taking one element in

this application, the initial diagnosis, briefly comparing the

processes adopted in medicine and law.

The Medical Case

Effective diagnosis is central to the practice of medicine. For that

reason it also forms a key element in the training of doctors. Here I

am not talking about the grand drama as presented in the US TV program

House where the team stumbles from one possibility to another in face

of complex and puzzling diagnostic problems, rather the more mundane

day to day application of diagnosis in practice.

I saw the importance placed upon the diagnostic during my two year

period as CEO of the Royal Australian (now Australian and New Zealand)

College of Ophthalmologists, the peak body responsible for the

training of future eye care specialists in Australia and New Zealand.

At the time the Victorian Government had decided to grant certain

prescribing rights to optometrists. The College's position was that

optometrists lacked the diagnostic skills necessary to prescribe those

drugs safely. There were some turf elements in this position among at

least some ophthalmologists, but overall it reflected a very strong

belief in the need for effective diagnosis to ensure protection of

patient interests.

Given that the Government was going to grant the rights, the College

argued that this should be made conditional upon optometrists

undergoing additional training. The College was then asked to advise

on just what additional minimum training should be mandated and why.

The word minimum is important. The College could not simply put

forward a shopping list whose effect would be to derail the process.

So we needed a structured process to both define what was required and

explain why. Importantly, the requirements had to be defined with

sufficient clarity to allow universities responsible for training

optometrists to incorporate them into future optometric training.

We adopted a competency based approach. These approaches are common in

education and training in Australia, New Zealand or Europe, less so in

the US. In simple terms, they involve defining what minimum level of

competence is required to do something effectively, defining how this

competence is to be measured, then specifying the necessary knowledge,

skills and judgment required to achieve that degree of competence.

I provided more information on these approaches in one of my earlier

posts on people management in professional services.

Application of these approaches to a specialist medical area was then

new and required our specialists to stand back and look at what they

did and why. One outcome was defined competencies relating to the

diagnostic process.

Comparison with Law

Now compare medicine and law.

When the patient comes to see the doctor, the doctor goes though a

structured process checking medical history, finding out any symptoms

from the patient, carrying out any necessary tests, developing a

diagnosis and then defining treatment. If necessary, the doctor will

refer the patient on for specialist advice.

The equivalent process in law is far less structured.

Putting it in medical terms, the patient comes to the doctor with

symptoms (I want a contract), the doctor then finds out what treatment

the patient thinks is required (what do you want to go into your

contract), then prescribes and makes the necessary drugs (the

contract) drawing from the in-house pharmacy (templates, precedents).

Perhaps not surprisingly, both misdiagnosis and wrong prescription are

not unusual. The problem may in fact not be a legal one at all. If a

legal problem, the real requirement may be different from that

specified by the client. In both cases, the final legal outcome is

likely to be unsatisfactory and may even be disastrous.

Linking all this back to my starting point, the knowledge domain I

defined as the application of the profession in practice by individual

professionals. Doctor/patient, lawyer/client etc. Essentially, how do

we do what we do.

My point about the medicine versus law comparison is that I think that

all professions can benefit from re-examination of the way they apply

their profession in practice. I also think that all professions can

benefit from examination of the way other professions undertake