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House MD: Solving Complex IT Issues Using Differential Diagnosis Steve Bennett Steve@DaemonSolutions.com @DaemonSteve Saturday, 30 June 12 AGENDA A Brief History Of Medical Diagnosis. Why & How You Should Prove Yourself Wrong.

  1. House MD: Solving Complex IT Issues Using Differential Diagnosis Steve Bennett Steve@DaemonSolutions.com @DaemonSteve Saturday, 30 June 12

  2. 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. Saturday, 30 June 12

  3. Who’s This Guy? Saturday, 30 June 12

  4. Why...? Saturday, 30 June 12

  5. Saturday, 30 June 12

  6. http://www.technologyreview.com/tr35/profile.aspx?TRID=1108 Saturday, 30 June 12

  7. Saturday, 30 June 12

  8. http://flic.kr/p/npaoT Saturday, 30 June 12

  9. http://4.bp.blogspot.com/_lSXhEtQUdtA/S-EL5w7dt3I/AAAAAAAAANE/G0oc_cGPXAY/s320/USAirways+in+the+water.jpg Saturday, 30 June 12

  10. Medical Diagnosis Saturday, 30 June 12

  11. http://4.bp.blogspot.com/-cCTr1WWve1E/TfefWAn8zvI/AAAAAAAAAA0/aXO50-syXuE/s1600/Imhotep_Museum-hd-1.jpg Imhotep - 2600BC Saturday, 30 June 12

  12. http://en.wikipedia.org/wiki/File:Edwin_Smith_Papyrus_v2.jpg Saturday, 30 June 12

  13. http://www.sculpturegallery.com/two/hippocrates3.jpg Hippocrates - 460BC Saturday, 30 June 12

  14. http://www.sculpturegallery.com/two/hippocrates3.jpg Galen - AD131 Saturday, 30 June 12

  15. In Summary; It’s Been Around A Long Time.. Saturday, 30 June 12

  16. Hypothetico-Deductive Model Saturday, 30 June 12

  17. William Whewell Saturday, 30 June 12

  18. "No amount of experimentation can ever prove me right; a single experiment can prove me wrong." Albert Einstein Saturday, 30 June 12

  19. Hypothetico-deductive model Saturday, 30 June 12

  20. Something unexplained happens. Saturday, 30 June 12

  21. http://www.flickr.com/photos/dougcaldwell/4213877479 Hypothesize. Saturday, 30 June 12

  22. Plan a test that can falsify . Predict the result. Saturday, 30 June 12

  23. Test. http://www.flickr.com/photos/kenilio/3351824931 Saturday, 30 June 12

  24. Hypothesize. Plan a test that can falsify. Predict. Test. Saturday, 30 June 12

  25. An Example. Saturday, 30 June 12

  26. I went shopping.. Saturday, 30 June 12

  27. Saturday, 30 June 12

  28. Saturday, 30 June 12

  29. Failed Card http://flic.kr/p/9MShdE Saturday, 30 June 12

  30. Saturday, 30 June 12

  31. Hypothetico-deductive model Saturday, 30 June 12

  32. Something unexplained happens. Saturday, 30 June 12

  33. Hypothesise. Saturday, 30 June 12

  34. I’ve Spent Too Much On SSD’s My Wife Has Been Shopping Hypothesise. There Is A System Problem I Didn’t Pay My Bill In Time Saturday, 30 June 12

  35. Plan a test. Predict. Saturday, 30 June 12

  36. Test: I’ll call the credit card company. Plan a test. Predict. Saturday, 30 June 12

  37. Test: I’ll call the credit card company. Plan a test. Predict. Prediction: I have sufficient funds. (If correct will falsify 3 hypothesis) Saturday, 30 June 12

  38. Test. Saturday, 30 June 12

  39. Test. Result: I have sufficient funds. Saturday, 30 June 12

  40. I’ve Spent Too Much On SSD’s My Wife Has Been Shopping Hypothesise. There Is A System Problem I Didn’t Pay My Bill In Time Saturday, 30 June 12

  41. Hypothesise. There Is A System Problem Saturday, 30 June 12

  42. Hypothetico-Deductive Model Hypothesise. Plan a test that can falsify . Predict. Test. Saturday, 30 June 12

  43. Differential Diagnosis. Saturday, 30 June 12

  44. Or DDx Saturday, 30 June 12

  45. What is it? Saturday, 30 June 12

  46. It’s that thing that House does. Saturday, 30 June 12

  47. It's a framework for problem diagnosis. Saturday, 30 June 12

  48. It's best used alongside the hypothetico-deductive model. Saturday, 30 June 12

  49. Process of elimination. Saturday, 30 June 12

  50. Assume most obvious. Until proved otherwise. Saturday, 30 June 12

  51. "When you hear hoof beats, look for horses, not zebras" Saturday, 30 June 12

  52. Saturday, 30 June 12

  53. Probability is your friend. http://www.flickr.com/photos/nashnosh/5922580484 Saturday, 30 June 12

  54. Personalised probability is your best buddy. http://www.flickr.com/photos/el5ajoola/3868649830 Saturday, 30 June 12

  55. Here’s how it works. Saturday, 30 June 12

  56. Something happens. Saturday, 30 June 12

  57. Something bad happens. Saturday, 30 June 12

  58. Something bad and complicated happens. Saturday, 30 June 12

  59. Gather the facts... Saturday, 30 June 12

  60. Gather the facts... Symptoms Saturday, 30 June 12

  61. Gather the facts... Symptoms Subject history Previous test results General observations Saturday, 30 June 12

  62. What else do we know? Saturday, 30 June 12

  63. http://www.flickr.com/photos/dougcaldwell/4213877479 Hypothesise. Saturday, 30 June 12

  64. List Hypotheses. Saturday, 30 June 12

  65. Immediately discount. Apply probability. Saturday, 30 June 12

  66. Prioritise hypothesis based on risk and probability. Saturday, 30 June 12

  67. Plan tests. Predict results. Saturday, 30 June 12

  68. Test. Or Treat. Saturday, 30 June 12

  69. Feedback results. Saturday, 30 June 12

  70. Continue until diagnosis is confirmed. http://www.o-min.com/wp-content/uploads/mobius1-300x225.jpg Saturday, 30 June 12

  71. Differential Diagnosis. Gather the facts. Hypothesise. Apply Probability. Prioritise. Test or Treat. Loop. Saturday, 30 June 12

  72. Diagnostic Approach Saturday, 30 June 12

  73. Possibilistic Saturday, 30 June 12

  74. Possibilistic All Possibilities Are Equal Test Everything Saturday, 30 June 12

  75. Possibilistic All Possibilities Are Equal Test Everything Saturday, 30 June 12

  76. Probablistic Saturday, 30 June 12

  77. Probablistic Selection Based On Probability Prioritise The Most Likely Saturday, 30 June 12

  78. Probablistic Selection Based On Probability Prioritise The Most Likely Saturday, 30 June 12

  79. Prognostic Saturday, 30 June 12

  80. Prognostic Selection Based On Most Serious Prioritise The Most Serious Saturday, 30 June 12

  81. Prognostic Selection Based On Most Serious Prioritise The Most Serious Saturday, 30 June 12

  82. Pragmatic Saturday, 30 June 12

  83. Pragmatic Selection Based On Responsiveness To Treatment Prioritise The Most Easily Treated Saturday, 30 June 12

  84. Pragmatic Selection Based On Responsiveness To Treatment Prioritise The Most Easily Treated Saturday, 30 June 12

  85. When do I use each approach.. Saturday, 30 June 12

  86. Do something and do it fast... Pragmatic. Saturday, 30 June 12

  87. If it really is that, we are in a world of hurt. Prognostic. Saturday, 30 June 12

  88. Default = Probabilistic. Saturday, 30 June 12

  89. I want more probability... Saturday, 30 June 12

  90. Pre & Post Test Probability. Current Probability: 30% 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. Saturday, 30 June 12

  91. This is easier in medicine. Saturday, 30 June 12

  92. Differential Diagnosis... ! Diagnostic Approach... ! Saturday, 30 June 12

  93. Diagnostic Thresholds Saturday, 30 June 12

  94. Define the point at which something is worth testing. Saturday, 30 June 12

  95. Probability of Diagnosis 0% 100% Test Treatment High Priority Tests Threshold Threshold Not Worth Worth Worth Testing Testing Treating Saturday, 30 June 12

  96. Mnemonics. Saturday, 30 June 12

  97. Doctors Love Mnemonics. Saturday, 30 June 12

  98. Mnemonic for DDx. Saturday, 30 June 12

  99. Vascular Idiopathic/Intoxication Neoplastic Degenerative/Deficiency Inflammatory Congenital Autoimmune/Allergic Traumatic Endocrine Saturday, 30 June 12

  100. Mnemonic for Acute Pancreatitis. Saturday, 30 June 12

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