Medical Informatics' Questions

It was a pleasure to read this interview with the visionary and inspiring Dr Weed. I was given his 1969 book to read, by a professor of medicine and important mentor of mine, while I was still a college student on an internship at a medical school research lab. I have had the pleasure of hearing Dr Weed speak on 2 or 3 occassions and his thinking has had an important impact on me.

As a description of the POMR and PKC journey, I think this interview is of interest and is good to publish. That said, I had some questions that I would love to have been able to ask the author- some of which are below.

Knowledge Couplers require "detailed data collection", which implies time, effort on the part of the patient or family (who may be unable or unwilling to comply), and abstraction/interpretation of responses and of physical exam findings by an observer. How do you overcome these barriers and sources of potential error? As a computer program, the PKC is only as good as the data it has to work with ("GIGO").

How is accurate and reliable medical knowledge developed and encoded into knowledge couplers, absent evidence based medicine?

Are randomized controlled trials and similar means of developing reliable knowledge about what works and what does not work to diagnose, treat and manage disease not still fundamental in the paradigm you describe?

Do not PKCs also have to use some type of relevancy ranking (statistical or otherwise) to prioritize diagnostic possibilities when there is not a single diagnosis that is certain based on the available data? If so, how is this fundamentally different from "an evidence based ranking"?


Michael Krall, MD
Primary Care Physician,
Medical Informatics