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April 2008 - Keep it Simple Stupid!

Wow, double digits in April already! 100 days behind us, 264 to go. What have I to show for it? All those plans and resolutions to simplify life seem to have been for nought. Every year the ante seemed to be upped. Yes I have been heard to observe "We all need challenges", but do I really need all of them? Silly man!

I have been pondering simplification in a number of contexts lately. The first was a request to simplify our laboratory reports as other departments within the hospital have done. It seems doctors don't understand the parameters we report. I support 100% the idea that information must be presented in a clear and meaningful way and I work hard to do that in anything I write or present. However, simplification in this context was more about stripping down and being minimalist. If the information is not going to be understood, remove it.

I am sure we have all experienced the phonecall from a junior doctor who is requesting lung function tests but has little or no idea what they are ordering. On occasions they don't even know what question is being asked. Furthermore, it is not at all uncommon for tests to be requested that will not answer the proffered question.

I have also been asked to do tutorials for medical students on pulmonary function testing at 4th and 6th year levels. Again the advice is "Keep it simple".

My trusty Oxford dictionary offers a number of meanings for the word simple among which are:

  1. Easily understood
  2. Not complicated or elaborate
  3. Absolute, unqualified, straightforward
  4. Foolish or ignorant
  5. Unsophisticated
  6. Of low rank, humble, insignificant.

Now, in my book at least, definitions 1-3 are keys to any successful communication, if it is to be clear and the message understood. This can be achieved, however, by two diametrically opposed approaches. The first is the careful exposition of concepts and ensuring understanding as you go. The alternative is to reduce the content to a minimum and ensure that only material the audience is already familiar with is included. Both approaches yield an easily understood, uncomplicated and straightforward presentation from the audience's perspective. However, I would argue that adopting the second approach disqualifies the exercise as a teaching session. It could also be argued that this latter approach implies that the consumers of the material are simple folk, hence the need for simple material.

This raises a dichotomy for us in terms of our profession. We are constantly working towards improving our knowledge, our relevance and our expertise. Should we be working towards a minimalist approach to conveying the results of the tests we do? Or, should we be empowering people to use the information we can provide.

As with the presentation scenario, I see two opposing approaches here. The first is to strip down to minimal information so that no new concepts or ideas are introduced eg FEV6. The second is to empower the people requesting the tests and receiving the reports to use the information we can provide in clinically useful ways. The former approach ensures stagnation, the latter advancement. If advancement does not result from empowerment, it would follow that pulmonary function testing is of limited clinical relevance.

There are a lot of factors that are driving this need for simplification. Guidelines (the product of committees) suggest numbers for thresholds of disease severity that are not always appropriate, much clinical teaching is based on information from the earlier days of pulmonary physiology being accessible to all (it wasn't very long ago that clinical respiratory laboratories were established) and fewer consultants have a well developed grounding in respiratory physiology.

I believe we need to take the empowerment route. The road may be long and at times arduous, but to adopt any other approach is devaluing our profession and shortchanging our patients. I also believe, we are the ones who have to do the job.

Next time you are asked to keep things simple, I suggest you review the various meanings of the word simple and ponder the KISS principle.

'til next time,


April, 2008




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Monday, 27 February 2012, 21:59:59