Genex: A Medical Scenario


This is the script for medical scenario in Ben Shneiderman's Opening Plenary Address "Codex, Memex, Genex: The Pursuit of Transformational Technologies" at CHI98.
Ben Shneiderman 3/29/98


Dorothy Gale has returned from her adventure in the Emerald City in the Land of Oz.

Unfortunately she is running a high fever and has a Ruby Red Rash on her feet. Her aunt takes Dorothy to Doctor Louise Pasteur, who examines Dorothy and does a series of blood tests.

Dr. Pasteur studies Dorothy's medical history of previous hospitalizations, examining X-rays and electrocardiograms but these seem normal. The Ruby Rash symptom is serious, and unusual so Dr. Pasteur decides to examine a Diagnostic reference source, linking to it by way of symptoms.

Many potential diagnoses appear but the strongest linkage for Ruby Rash is to Munchkin Syndrome, also known as Redmond Rash. Munchkin Syndrome commonly leads to disorientation, and loss of memory. It was discovered in 1982 by Dr. William Gaitze.

To verify this diagnosis, Dr. Pasteur selects the primary symptom - high Toto cell counts and links back to the LifeLine. Sure enough Dorothy's LifeLine indicates that the last blood test showed a high Toto cell count of 81 and another anomaly, a high blood density of 7.

This is a somewhat unusual situation so Dr. Pasteur decides to consult a digital library containing 231 million patient histories.

She extracts four thousand cases of Munchkin Syndrome and trims the set to 308 cases of those with similar age and genetic background to Dorothy. Then Dr. Pasteur explores possible treatments by displaying the cases with Toto cell initial counts on the x-axis and the amount of reduction on the y-axis. In this Spotfire display, red points are females and blue points are males. Size encodes blood density.

She explores treatments by pulling through "chemotherapy", "dialysis", "interferon", and "surgery". Chemotherapy is used only with women, dialysis is the favored treatment, interferon has only moderate impact,and surgery is seen as too risky.

For high Totocell initial cases, dialysis has the highest Toto cell reduction for patients like Dorothy. However, Dorothy's family has a common genetic pattern of high blood density which may reduce the effect of the dialysis. Sure enough, a scan through the blood densities shows that those with high blood density do not do as well with dialysis.

But Dr. Pasteur is an expert on blood density and believes that a blood thining treatment may make the dialysis more effective. So she runs a simulation that introduces blood thinning drugs at 10mg/minute.

The simulation doesn't show a sufficient effect, so Dr. Pasteur decides to grab the simulation history and re-run it while changing the blood thining drugs from 10 to 100mg/minute.

She finds an optimum decline of Toto cells at 50 mg/min, but Dr. Pasteur is worried about the blood thinning problem and decides to consult with the developer of the dialysis treatment method for Munchkin Syndrome, Dr. Lyon. Dr. Pasteur sends Dorothy's case history, links to the patient database, and the dialysis simulation results to Dr. Lyon.

A few hours later Dr. Pasteur has a consultation with Dr. Lyon, who is intrigued by the simulation results, and confirms the 50mg/min rate. Dr. Lyon signs on as a consultant, affirming the treatment plan.

Dr. Pasteur now sends Dorothy for the dialysis, and her Toto cell count drops quickly as the rash fades away. The treatment is a success.

Dr. Pasteur records the positive outcome and then disseminates the results. She adds her revised treatment template to the database and sends an email note to physicians that are treating similar cases to inform them of this case. Then she begins to write up this case for the New England CyberJournal of Medicine.


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