Much time has been spent over the last month procesing the rather numerous photos I took whilst in Nepal and India recently. I have developed the habit of shooting in "RAW" which produces an image file that is akin to a digital negative that still has to be developed. Shooting in JPEG allows the camera to interpret the digital information from the sensor the way the manufacturer thinks it should be processed. There is inherently nothing wrong with that and it saves a lot of time and effort. The main result is that all photographs are treated in the same way. This tends towards images being more average, a bit flat and often failing to stimulate the memory you had of the scene and the reason you took the photo.
The photo on the left, taken at the Bodhnath Stupa in Kathmandu, is as the camera thought it should look. I find it flat and lacking the essential vibrancy of colour in the prayer flags and buildings that triggered the image in the first place. The camera is literally painting by numbers.The one on the right has had individual attention in terms of developing the RAW data. Most would agree that the colours are richer and the image is a lot punchier than the camera version. This is much closer to what I recall from the time of taking the image and, I think, better captures the effect of the prayer flags and bright buildings. There is scope for much more Photoshop work here to further improve the image, but that is another story. There is no right and wrong in the images and one is not necessarilly better than the other. Many are the arguments that the camera sees what was there and that processing the image is changing things. Nothing has been added or subtratced in this exercise. The same information is there, it has simply been interpreted differently to, hopefully, better represent the emotion that led to the photo being taken.
While sitting at my MAC selecting images to work on and keep, I found myself wondering about similar discussions I have had recently about data selection for our PFT reports and choices of protocols for exercise testing. We have guidelines for pretty much everything we do today. The ATS/ERS tell us to select the highest values for FEV1, FVC and other indices and most systems do this automatically. I often find myself pondering whether the flow loop that provides the highest numbers is indeed the best representation of the patient's airway function. I indeed often find myself selecting the data based on my interpretation of the function rather than slavishly following the numbers.
Similarly it is very easy to lose sight of what we are doing by slavishly following guidelines when setting up an exercise protocol. Numbers produced by a guideline or protocol are fine for Mr or Mrs Average but the reality is that there is no such person. To get optimal data requires customization of a protocol to fit the subject's characteristics. Much of the ability to do this effectively depends on our experience and understanding of the physiological responses we are measuring. No matter how smart the computer is, the experienced scientist is smarter.
In like vein, distributing reports with an FEV1 and FVC but no loop is akin to always shooting in JPEG. The additional information available in the loop is thrown out just like the extra data available in the RAW image file is ignored when shooting JPEG images.
At the end of the day, computers and processors should be there to help us make good decisions not make them for us. When we allow them to make the decisions we abrogate our responsibilities to our patients. This "processing" may take time but, I believe, it is critically important in producing quality outputs.
Reporting by numbers will no doubt provide an adequate output in most cases. The question is, "Can we do better?"
This edition of ANZSRS.ORG.AU is my last for now. After 9 ½ years I have decided I need to hang up my keyboard. It has been a helluva ride and my sincerest thanks go to all those who have supported my efforts to make the web-site the cornerstone of the Society that it is today. I vividly remember the sinking feeling when President Brenton leaned over a mezzanine balcony and shouted the news to me that the Board of the day had appointed me to look after the web-site. My internalized response at the time was along the lines "I have no idea how I am going to deliver on this! What have I done?" It seems a very long time ago now.
Have I delivered on my vision back then? Traffic through the site has gone from 2,500 hits per month to 50,000 hits per month so I like to think I have achieved something. Trouble is, my vision for the site has grown over the years and I see further to go than I have come. New blood, new ideas are now central to the progress of the site. The time for change is here. It is time for me to step back and give others their head.
Alison Boynton has kindly offered to put the August edition to bed for you and hopefully there will be new recruits champing at the bit for the September edition.