House MD: Solving Complex IT Issues Using Differential
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Transcript of House MD: Solving Complex IT Issues Using Differential
House MD: Solving Complex IT Issues Using Differential Diagnosis
Steve Bennett
[email protected]@DaemonSteve
Saturday, 30 June 12
AGENDA
A Brief History Of Medical Diagnosis.Why & How You Should Prove Yourself Wrong.
Differential Diagnosis.Diagnostic Approaches.Diagnostic Thresholds.
Do’s, Don’ts & Application.
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Who’s This Guy?
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Why...?
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http://www.technologyreview.com/tr35/profile.aspx?TRID=1108
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http://flic.kr/p/npaoT
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http://4.bp.blogspot.com/_lSXhEtQUdtA/S-EL5w7dt3I/AAAAAAAAANE/G0oc_cGPXAY/s320/USAirways+in+the+water.jpg
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Medical Diagnosis
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http://4.bp.blogspot.com/-cCTr1WWve1E/TfefWAn8zvI/AAAAAAAAAA0/aXO50-syXuE/s1600/Imhotep_Museum-hd-1.jpg
Imhotep - 2600BCSaturday, 30 June 12
http://en.wikipedia.org/wiki/File:Edwin_Smith_Papyrus_v2.jpg
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Hippocrates - 460BC
http://www.sculpturegallery.com/two/hippocrates3.jpg
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Galen - AD131http://www.sculpturegallery.com/two/hippocrates3.jpg
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In Summary;It’s Been Around A Long Time..
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Hypothetico-Deductive Model
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William Whewell
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"No amount of experimentation can ever prove me right; a single experiment can prove me
wrong." Albert Einstein
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Hypothetico-deductive model
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Something unexplained happens.
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Hypothesize.
http://www.flickr.com/photos/dougcaldwell/4213877479
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Plan a test that can falsify.Predict the result.
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Test.
http://www.flickr.com/photos/kenilio/3351824931
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Hypothesize.Plan a test that can falsify.
Predict.Test.
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An Example.
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I went shopping..
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Failed Card
http://flic.kr/p/9MShdE
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Hypothetico-deductive model
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Something unexplained happens.
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Hypothesise.
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Hypothesise.
There Is A System Problem
My Wife Has Been Shopping
I Didn’t Pay My Bill In Time
I’ve Spent Too Much On SSD’s
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Plan a test.Predict.
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Plan a test.Predict.
Test: I’ll call the credit card company.
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Plan a test.Predict.
Test: I’ll call the credit card company.
Prediction: I have sufficient funds.
(If correct will falsify 3 hypothesis)
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Test.
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Test.
Result: I have sufficient funds.
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Hypothesise.
There Is A System Problem
My Wife Has Been Shopping
I Didn’t Pay My Bill In Time
I’ve Spent Too Much On SSD’s
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Hypothesise.
There Is A System Problem
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Hypothetico-Deductive Model
Hypothesise.Plan a test that can falsify.
Predict.Test.
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Differential Diagnosis.
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Or DDx
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What is it?
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It’s that thing that House does.
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It's a framework for problem diagnosis.
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It's best used alongside the hypothetico-deductive model.
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Process of elimination.
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Assume most obvious.Until proved otherwise.
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"When you hear hoof beats, look for horses, not zebras"
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Probability is your friend.
http://www.flickr.com/photos/nashnosh/5922580484
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Personalised probability is your best buddy.
http://www.flickr.com/photos/el5ajoola/3868649830
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Here’s how it works.
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Something happens.
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Something bad happens.
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Something bad and complicated happens.
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Gather the facts...
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Gather the facts...
Symptoms
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Gather the facts...
Subject history
Previous test results
Symptoms
General observations
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What else do we know?
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Hypothesise.
http://www.flickr.com/photos/dougcaldwell/4213877479
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List Hypotheses.
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Immediately discount. Apply probability.
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Prioritise hypothesis based on risk and probability.
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Plan tests.Predict results.
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Test.Or Treat.
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Feedback results.
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Continue until diagnosis is confirmed.
http://www.o-min.com/wp-content/uploads/mobius1-300x225.jpg
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Gather the facts.Hypothesise.
Apply Probability.Prioritise.
Test or Treat.Loop.
Differential Diagnosis.
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Diagnostic Approach
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Possibilistic
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Possibilistic
All Possibilities Are Equal
Test Everything
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Possibilistic
All Possibilities Are Equal
Test Everything
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Probablistic
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Probablistic
Selection Based On Probability
Prioritise The Most Likely
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Probablistic
Selection Based On Probability
Prioritise The Most Likely
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Prognostic
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Prognostic
Selection Based On Most Serious
Prioritise The Most Serious
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Prognostic
Selection Based On Most Serious
Prioritise The Most Serious
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Pragmatic
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Pragmatic
Selection Based On Responsiveness To Treatment
Prioritise The Most Easily Treated
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Pragmatic
Selection Based On Responsiveness To Treatment
Prioritise The Most Easily Treated
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When do I use each approach..
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Do something and do it fast...
Pragmatic.
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If it really is that, we are in a world of hurt.
Prognostic.
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Default = Probabilistic.
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I want more probability...
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Pre & Post Test Probability.
If the result is X;There is 60% chance of hypothesis being correct.
If the result is Y; There is 0% chance of hypothesis being correct.
Current Probability: 30%
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This is easier in medicine.
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Differential Diagnosis...Diagnostic Approach...
!
!
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Diagnostic Thresholds
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Define the point at which something is worth testing.
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0% 100%Test
ThresholdTreatmentThreshold
Probability of Diagnosis
Worth TestingNot Worth
TestingWorth
Treating
High Priority Tests
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Mnemonics.
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Doctors Love Mnemonics.
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Mnemonic for DDx.
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Vascular
Inflammatory
NeoplasticDegenerative/Deficiency
Idiopathic/Intoxication
CongenitalAutoimmune/Allergic
EndocrineTraumatic
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Mnemonic for Acute Pancreatitis.
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Gallstones
Mumps
TraumaSteroids
Ethanol
AutoimmuneScorpion bites
Drugs(azathioprine, diuretics)Hyperlipidemia
GET SMASH’D
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Mnemonic for the web...
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Cache/Code Application engine
Services (Third Party)Hardware
Web server
Operating systemUsers
Network
Database/DatastoreSaturday, 30 June 12
Cache/CodeApplication engineServices (Third Party)HardwareWeb serverOperating systemUsersNetworkDatabase/Datastore
CA$HWOUNDSaturday, 30 June 12
These are used to follow a path through trees.
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CA$HWOUND
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How can this all help me?
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It makes you more thorough.
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It can help you fix things faster.
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By working as a team.
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By working more efficiently.
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Reduces Thematic Vagabonding.
http://www.flickr.com/photos/neloqua/166353267
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Reduces Lone Wolf Heroism.
http://www.flickr.com/photos/tambako/3559257456
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Reduces Encystation
http://www.flickr.com/photos/tambako/3559257456
http://www.flickr.com/photos/emmacoulston/4442688125
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This is what it looks like.
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I’ve run out of diagnosis.
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You suck.:-)
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Then you’ve missed something.
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Question your results, symptoms and observations.
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Re-test if in doubt.
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Call in a fresh pair of eyes.
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Do’s and Don’ts
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Assemble a team.
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Get the right experts in the room.
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Experts and generalists.
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The diagnostic lead.
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Diagnostic Lead, controls the pen.
http://www.flickr.com/photos/scttw/1819085915
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Take it in turns to lead.Saturday, 30 June 12
Culture.
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Openness is key.
http://www.flickr.com/photos/41427839@N07/5973163369/
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Encourage people to challenge.
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And be challenged.
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Collaborate.
http://www.neale-wade.net/blog/wp-content/uploads/2008/08/100_1241.jpg
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Do not immediately dismiss ideas...
http://www.flickr.com/photos/albaflickr/4416770182/lightbox/
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Do not immediately dismiss ideas...
http://www.flickr.com/photos/albaflickr/4416770182/lightbox/
that were not yours...
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Do not immediately dismiss ideas...
http://www.flickr.com/photos/albaflickr/4416770182/lightbox/
that were not yours...or your team’s...
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There is a time to debate and a time to act.
http://www.flickr.com/photos/straubin/4541508733/
http://www.flickr.com/photos/54182266@N02/5017666438
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Get better at making group decisions.
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Build a culture that encourages creative suggestions.
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Practice makes perfect.
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When do I use this..?
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Complex Problems.
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Active Problems.
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Post Mortem
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Conclusion
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Try and prove yourself wrong.
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DDx is a framework that YOU can use to resolve & manage your complex problems.
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Be aware of the Diagnostic Approach that you are using and why.
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Create a Mnemonic for your system.
It acts as a checklist.
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Watch House.
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Further Reading;The Process of Diagnosis (AMA) -
http://medicine.ucsf.edu/education/resed/articles/jama6_the_process.pdf
Jessie Robbins - Creating Resiliency Through Destruction-http://www.slideshare.net/jesserobbins/ameday-creating-resiliency-through-destruction
All of John Allspaw’s presentations- http://www.slideshare.net/jallspaw
House MDhttp://www.fox.com/house/
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Thank You.:-)
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