Human factors in medicine

I just watched the latest BBC Horizon programme. It was about the need for developing human factors training and practice in medicine. It drew on the civil aviation industry, and also fire fighting and Formula 1.

My wife could tell you that the need for human factors training within medicine is something that I've been banging on about for years. It's been apparent that whilst there are many very good and well-intentioned practitioners of all sorts within the NHS, there are also too many occasions when issues arise that really boil down to human factors end up having a negative clinical outcome. This is something that has been a focus of training and safety within aviation since Kegworth, and over and over again, when I hear descriptions of events that have taken place in hospitals, I can think of ways in which human factors training could have helped.

Aspects drawn from aviation in this episode included the use of checklists (although checklists themselves are an innovation, the idea of following "protocols" and procedures are already widely established within medical practice), a strong focus on situational awareness, mention of the need to understand the impact of authority gradients, and the impact of too much stress.

It's easy to add other aspects of human factors issues from aviation (now generally called CRM - crew resource management). For example, fatigue, error chains (mentioned passim without explanation) and communication. One of the major contributors to improvements in the human factors environment within aviation has been CHIRP - the Confidential Human Factors Incident Reporting Programme - which has been extended to Air Traffic Control, cabin crew, aviation engineers and also the maritime industry. Again, for years, I've been saying that if the NHS were to take human factors seriously, such a publication would greatly benefit.

Dr Kevin Fong, the presenter, makes a very good and articulate case for the development of human factors within medical practice. If Sir David Nicholson, the Chief Executive of the NHS, is keen to see substantial improvements in clinical outcomes, I'm pretty convinced that this is one of the places that he should be looking.

Francis Schaeffer on logical positivism

Logical positivism claims to lay the foundation for each step as it goes along, in a rational way. Yet in reality it puts forth no theoretical universal to validate its very first step. Positivists accept (though they present no logical reason why this should be so) that what reaches them from the "outside" may be called "data"; i.e., it has objective validity. 

This dilemma was well illustrated by a young man who had been studying logical positivism at Oxford. He was with us in Switzerland as a student ... and he said one day, "I'm confused about some of these things. ... when this data reaches you ..." 

At once I said, "How do you know, on the basis of logical positivism, that it is data?" 

He started again, and went on for another sentence or two, and then said a second time, "When this data reaches you ..." 

...I had to say, "No, you must not use the word data. It is loaded with all kinds of meaning; it assumes there is objectivity, and your system has never proved it." 

"What do I say then?" he replied. 

So I said, "Just say blip. You don't know what you mean by data, so substitute blip." 

He began one more, "When blip reaches you ..." and the discussion was over. On the basis of their form of rationalism, there is just as much logic in calling something "blip" as "data." 

Thus, in its own way, though it uses the title of positivism and operates using reason, it is just as much a leap of faith as existentialism - since it has no postulated circle within which to act which validates reason nor gives a certainty that what we think is data is indeed data. 

Michael Polanyi's (1891-1976) work showed the weakness of all forms of "positivism" and today positivism in theory is dead. However, it must be said that the materialistic, rationalistic scientists have shut their eyes to its demise and continue to build their work upon it as though it were alive and well. They are doing their materialistic science with no epistemological base. In the crucial area of knowing, they are not operating on facts but faith.

Francis Schaeffer, "The God who is there", emphasis mine.

The trouble is that there are many non-scientists who have accepted the epistemological assertions of the "materialistic, rationalistic scientists" who "have shut their eyes" the the demise of their epistemological foundation, that science is an adequate philosophical foundation for not believing in God. "Well, we know so much more than we used to know. It used to be necessary to believe in God to explain the world around us. But nowadays, we are much better informed, and belief in God is not necessary."

Science as a philosophy - "scientism", if you like - is not built on a solid foundation. For example, Richard Dawkins said: "Although atheism might have been logically tenable before Darwin, Darwin made it possible to be an intellectually fulfilled atheist." This is not a logical statement. Firstly, although Darwin provided a naturalistic and gradualistic explanation of how life might arise, this actually has no bearing on whether or not there is a god (which is, in effect, what Dawkins is claiming). Secondly, what is absent from Darwin's (and Dawkins') work is reference to an epistemological foundation. It is a justification of this which would provide the possibility to be an intellectually fulfilled atheist, rather than a description of phenomena. Questions such as: how does life differ from non-life? what is consciousness? what is communication? why do the things that matter so much to us - truth, love, beauty, justice - seem to have so little to do with the physical nature of the universe?

This isn't to say that science is bunk. On the contrary, the achievements of science in explaining the nature of the universe are immense and wonderful. Also, some scientists have made sincere attempts to answer these questions. But like the student that Schaeffer talked to, their answers are not philosophically complete.

Science is not the sole preserve of logical positivists. In fact, the foundations of modern science were laid by people with a very different philosophical framework - Christians, who believed that the foundation for belief in the objective validity of data was the existence of a deity, an external absolute reference point. Christians still do science today. It's uncommon for their books to be as successful as those of the logical positivists who haven't comprehended their mislaid foundation yet, though.

Frustration with "AirPort" on Mac

We have a wireless network, and one of the frustrations we've had with our Macbook is that, pretty much whenever it entered "sleep" mode, it would fail to reconnect properly to the network. Resetting this was taking up to half an hour a day - particularly bad since the major selling feature of Apple products is that they should "just work".

This was getting gradually worse as time went on. I'd come to the conclusion that it was something to do with IP address conflicts - switching an extra computer on would quite often trigger a period of misbehaviour. Our house now has four phones, a TV, five computers, a wireless printer, a couple of e-readers and several games consoles which drop on and off the network. The potential for IP address conflicts was getting steadily worse, and the Macbook in particular was getting more and more flaky. The problem has been known about for years, but Apple have been singularly poor at working out a fix. Something had to be done - or the Macbook was likely to experience defenestration.

A further complication, which may or may not have made the situation worse, was the addition of a wireless network extender. This had the benefit of making the internet available in the furthest reaches of the house (which is not actually that huge!), but created the complication of (apparently) having two different networks with the same SSIDs. This had various implications - it was not possible to tell whether a computer and the wireless printer were actually on the same network until data failed to make it to the printer.

It was all pretty bad. But I think we may have found a way forward.

Devices on the network are identified by a MAC address. This is a number which is six two-digit hexadecimal numbers in a row, separated by colons, and every device capable of accessing a network has a different one (I suppose). Some wireless routers have the option of "reserving" an IP address for a particular device. So I found the Macbook's MAC address, entered the configuration page for the wireless router (a Virgin Media Superhub), and asked it to reserve the IP address for that Macbook. A slight additional complication was that I had to change the name in the Macbook "Sharing" section of its System Preferences - it had a name, but until I changed it, this wasn't being made available on the network, and the wireless router needed a name to reserve the address.

In doing this, I discovered that the Superhub was somewhat more super than I'd expected. It actually has the option of running multiple wireless networks. So I then set up a second wireless network - I now have networks with the SSIDs virginmedia12345678 and extension12345678. The printer and the Macbook and most things within reach of the router use the first one. But the network extender uses the second one, and this means that most devices can ignore its behaviour altogether. So people on "that" side of the house get wireless internet, and it doesn't interfere with devices on "this" side of the house.

I'll let you know if this turns out not to resolve the issue long term, but it looks like we've found a workaround for Apple's inadequacies.

In the meantime, I've come across a new problem. The Superhub has an ongoing issue that after a while, it stops being possible to access the administration screens using the standard IP address. Like the Airport fault on Apple, this has been flagged up for years, and Virgin have apparently failed to achieve much by way of fixes. Apparently, restarting it allows access again - and fortunately we will hopefully not have to access the configuration pages on a very frequent basis. So I think I can live with this.