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Searching	
  for	
  metaphors:	
  	
  
Naviga4on	
  in	
  turbulent	
  waters	
  
                           Paul	
  Dorian	
  
          Director	
  ,	
  Division	
  of	
  Cardiology	
  
 St	
  Michael’s	
  Hospital	
  ,University	
  of	
  Toronto	
  
  Professor,	
  Departments	
  of	
  Medicine	
  and	
  
       Pharmacology,	
  University	
  of	
  Toronto	
  	
  
In theory, theory is as good
        as practice.

     In practice, it isn’t

              Yogi Berra
Alan	
  Trive;,	
  execu4ve	
  director	
  of	
  Triathlon	
  Canada,	
  is	
  calling	
  physiologists	
  and	
  doctors	
  involved	
  
in	
  Paula	
  Findlay’s	
  care	
  to	
  determine	
  how	
  her	
  case	
  of	
  iron	
  deficiency	
  could	
  have	
  been	
  missed	
  
before	
  she	
  competed	
  at	
  the	
  London	
  Olympic	
  Games.	
  
The	
  revela4on	
  about	
  Findlay’s	
  iron	
  deficiency	
  came	
  this	
  week	
  aJer	
  she	
  blogged	
  that	
  low	
  iron	
  
levels	
  likely	
  had	
  a	
  “huge	
  impact”	
  on	
  her	
  disastrous	
  last-­‐place	
  finish	
  in	
  London.	
  She	
  discovered	
  
the	
  problem	
  only	
  last	
  week	
  aJer	
  staff	
  at	
  her	
  new	
  training	
  base	
  in	
  Guelph,	
  Ont.,	
  ordered	
  the	
  tests	
  
because	
  she	
  had	
  been	
  feeling	
  sluggish.	
  	
  
Findlay	
  says	
  she	
  saw	
  the	
  May	
  results	
  for	
  the	
  first	
  4me	
  this	
  week.	
  “It’s	
  pre;y	
  clear	
  that	
  they	
  
dropped	
  a	
  lot,”	
  she	
  said.	
  “They	
  were	
  lower	
  than	
  they’d	
  ever	
  been	
  in	
  May.	
  And	
  then	
  in	
  August,	
  
they	
  were	
  lower.”	
  
	
  




     Toronto	
  Globe	
  and	
  Mail	
  Sept	
  12,	
  2012	
  	
  
     Hayley	
  Mick	
  	
  
PHeMI:	
  Personal	
  Health	
  	
  Management	
  Ini4a4ve	
  
Priniciples	
  from	
  the	
  trenches	
  	
  	
  
•  Prefer	
  simplicity	
  to	
  complexity	
  unless	
  complexity	
  
   is	
  totally	
  invisible	
  
•  What	
  pts	
  want	
  is	
  a	
  doctor	
  who	
  looks	
  them	
  in	
  the	
  
   eye	
  and	
  listens,	
  and	
  does	
  not	
  look	
  	
  to	
  a	
  screen	
  
•  Very	
  smart	
  people	
  have	
  spent	
  a	
  decade	
  and	
  
   hundreds	
  of	
  millions	
  of	
  $	
  to	
  design	
  systems	
  of	
  
   informa4on	
  entry,	
  	
  retrieval,	
  management,	
  
   processing.	
  Why	
  have	
  they	
  failed	
  to	
  find	
  an	
  
   overall	
  	
  sa4sfactory	
  solu4on?	
  
It’s	
  all	
  about	
  the	
  user	
  interface	
  
  Most	
  important	
  :	
  
  simplicity,	
  transparency	
  and	
  usability	
  
  	
  
  Less	
  important:	
  
  Complexity	
  and	
  comprehensiveness	
  	
  
  	
  
  	
  
  	
  
  Design	
  from	
  need	
  ,	
  ie	
  perceived	
  need	
  ,	
  
  not	
  from	
  design	
  poten4al	
  .	
  

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Paul Dorian Presentation ~ The Data Effect

  • 1. Searching  for  metaphors:     Naviga4on  in  turbulent  waters   Paul  Dorian   Director  ,  Division  of  Cardiology   St  Michael’s  Hospital  ,University  of  Toronto   Professor,  Departments  of  Medicine  and   Pharmacology,  University  of  Toronto    
  • 2. In theory, theory is as good as practice. In practice, it isn’t Yogi Berra
  • 3. Alan  Trive;,  execu4ve  director  of  Triathlon  Canada,  is  calling  physiologists  and  doctors  involved   in  Paula  Findlay’s  care  to  determine  how  her  case  of  iron  deficiency  could  have  been  missed   before  she  competed  at  the  London  Olympic  Games.   The  revela4on  about  Findlay’s  iron  deficiency  came  this  week  aJer  she  blogged  that  low  iron   levels  likely  had  a  “huge  impact”  on  her  disastrous  last-­‐place  finish  in  London.  She  discovered   the  problem  only  last  week  aJer  staff  at  her  new  training  base  in  Guelph,  Ont.,  ordered  the  tests   because  she  had  been  feeling  sluggish.     Findlay  says  she  saw  the  May  results  for  the  first  4me  this  week.  “It’s  pre;y  clear  that  they   dropped  a  lot,”  she  said.  “They  were  lower  than  they’d  ever  been  in  May.  And  then  in  August,   they  were  lower.”     Toronto  Globe  and  Mail  Sept  12,  2012     Hayley  Mick    
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. PHeMI:  Personal  Health    Management  Ini4a4ve  
  • 12. Priniciples  from  the  trenches       •  Prefer  simplicity  to  complexity  unless  complexity   is  totally  invisible   •  What  pts  want  is  a  doctor  who  looks  them  in  the   eye  and  listens,  and  does  not  look    to  a  screen   •  Very  smart  people  have  spent  a  decade  and   hundreds  of  millions  of  $  to  design  systems  of   informa4on  entry,    retrieval,  management,   processing.  Why  have  they  failed  to  find  an   overall    sa4sfactory  solu4on?  
  • 13. It’s  all  about  the  user  interface   Most  important  :   simplicity,  transparency  and  usability     Less  important:   Complexity  and  comprehensiveness           Design  from  need  ,  ie  perceived  need  ,   not  from  design  poten4al  .