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The Tale of Two Doctors

T Ashok
T Ashok
Founder and CEO, STAG Software Private Limited
Ashok is the Founder and CEO of STAG Software Private Limited, Bangalore, India, a company that s... more>>
In a big city lived Joe, a typical urban yuppie. He was always focused on a great tomorrow. He worked very hard, partied furiously and lived a fast life.

Life was a blast, until his body decided to act up. On this Sunday morning, he woke up panting, unable to breathe, body drenched in sweat, with a dull pain in his chest. The previous evening was a blast, a celebration party thrown for his best buddy getting engaged. After an evening spent at bowling, they hit the pubs, closing each one, until they could not find one open.

A typical Sunday morning would commence at noon; today, as he was rudely jolted out of his reverie, the bright LED clock showed 7:00.He could not move his arms, it seemed to take a tremendous effort to reach out for the bottle of Evian on the table near his bed. He had read about old age diseases getting younger in these modern times, dismissed them brashly, a reflection of his supreme yuppie confidence. For once he faltered, worried seriously if he could become one of the stories. All these years, he had thought of God of as a fashion statement but today he genuinely wished to believe that God exists. For the next few seconds, which seemed like an eternity, his mind rapidly flew back over the past years on the constant abuse he had heaped on his body. For once he prayed dearly that he would do the right things, if he was excused this time. The clock glowed 7:02, and he realized it had been the longest two minutes of his life.

At 8:55 a.m he was in the reception of GoodLife hospital for a 9AM appointment with Dr Robert Black Sr., a senior and very experienced cardiologist. He was soon ushered in, and was face to face with a severe yet friendly gentleman, a few orderly strands of golden hair on his shiny head with a piercing pair of eyes. "Mr Joe, would you please tell me your problem?" said Dr. Black. Joe described in detail his travails upon his rude awakening.

An old school doctor, he believed in detailed physical examination rather than the fancy modern equipment. "Lie down on the bed and relax Mr Joe". He took his stethoscope, placed it on his chest and listened carefully. "Breathe in and out deeply now" said the doctor as he continued to hover his steth on various parts of chest. His sharp eyes showed no emotion, as he went about his job confidently. The young nurse standing next to the doctor was petite and beautiful. She dispassionately took out the sphygmomanometer, wrapped the elastic band around Joes arm, pumped it up and watched the mercury bobbing up and down, while her other hand measured the pulse. After a minute, she looked at Dr Black and said 140/120 and 93, in a husky voice.

"Mr Joe, have you been feeling very tired at the end of day lately?"
"Yes" he said and added "It is the busy time of the year at work, a string of late nights."

"What kind of work do you Mr Joe?"

"I work in the software industry. We are in midst of building a cool application for mobile phones."

"Oh I see, you are the software guy.My nephew is in the software business too and is always racing against time."

"I guess you must be tied to the desk most of the time. Do you exercise?"

"Well doctor, the days are long and busy, I catch up on my sleep over the weekend. I try to workout in the gym over the weekends, but it is challenging"

"I see that you are smoker, do you drink? And are you a vegetarian?"

"Well doctor, I do drink, and I am not vegetarian."

Dr Black was one of the most famous cardiologists in the country. He was a master at diagnosis, believed in scientific and systematic study of symptoms and their connections. He placed his gold-rimmed glasses on the table, rubbed his finger on his chin, leaned back on his cozy leather chair and his piercing eyes looked straight into Joe and said "Mr Joe, you have issue with the blood supply to the heart muscles, there seems a advanced arterial block. It is necessary that you undergo angioplasty, a procedure to relieve the constriction very quickly within a fortnight."

Joe sat still, staring at the statement "The most amazing non-stop machine.Take care." written on a poster containing the picture of heart, which prominently on the wall behind the doctor.

Dr Black who was used to these reactions, jolted Joe out of the reverie "Mr Joe, you need to quit smoking and go vegetarian. You are young, the angioplasty procedure has a high success rate and you should be back on to active life quickly." Dr Black believed in conveying news straight, and expected patients to face reality and act on the problem. "Mr Joe, you would need to be in the hospital for 3-4 days, do decide on the date quickly. As I mentioned before, it is important that you act on this within a fortnight. It is painless procedure and should be fairly straightforward in your case. Mr Joe, do you have any questions?"

"No doctor, I have none" replied Joe mechanically, his ability to think numbed by the turn of events. As he exited the consulting room, the receptionist, a cheerful and bubbly woman in twenties whispered "Have a good day Mr Joe" with a beautiful smile, a genuine one. It had the effect, and for a moment he felt cheerful and returned the smile, a little weakly though.

As soon as he was outside the hospital, his hand went mechanically to his shirt pocket containing the cigarette packet. "Smoking kills" said the packet loudly and he threw the packet on the wayside.

David, his roommate had just woken up as Joe returned to his apartment. "Hi, had breakfast? Got some muffins and bagels, want some?" said David. "No thanks" mumbled Joe.

After a few minutes David understood the reason for the strange behavior of his best friend. "Come on man, let us get a second opinion right away". David was one who never lost his cool and his level headed thinking in tough situations was one that helped his friends many a times.

At 10:50 they were at ValleyTech hospital for consultation with Dr James White. He had been referred by Davids boss, who had undergone a heart bypass a few months at ValleyTech.

At 11:05 Joe was called in. "Good morning Joe. Please sit down. I have read your case sheet and have a few questions. Do you have any recent ECGs?
"No doctor" said Joe.

"I know your company has a yearly health check plan for all, as our hospital administers it. So have you not taken it this year?"
"No doctor, the last few months has been very hectic and I have not had my yearly checkup yet" said Joe.

Dr White was a modern doctor who relied on technology in diagnosis and treatment. A young cardiologist,he believed in seeing the internals before the scalpel touched the body. He was amazed at the advancements in radiology and made it a point to recommend a few pictures to be taken before he touched a patient.

Unlike Dr Black who believed in the power of external examination, Dr White believed in the looking at internals for diagnosis and treatment. Dr White had immense faith in scans, lab tests and preferred analyzing reports to spending time on and performing examinations on patients.

"Please get the ECG done now. I would like to see the report first. Thank you."

Joe went to the diagnostic lab in the adjoining building. When his turn came, he went inside, removed his shirt, the technician smeared jelly on his chest and proceeded to stick colorful leads at various points. In a few seconds, the needle was dancing, drawing patterns on the strip of paper. The technician looked at the squiggles on the paper with a bored expression, and after a few minutes, decided the machine has had its share of fun and switched it off. He tore the roll of paper, scanned it intently, and then proceeded to fold it and inserted into a cover. Joe was curious to know what the squiggles meant and asked "Is it normal?".

"It seems fine,expect for a small spike here" replied the technician. He had seen hundreds of such squiggles and knew exactly as to what was normal,but he was no doctor to interpret any abnormalities.

Joe stared at the report, the squiggles held a secret that Joe was scared about. "Hey, lets go meet to the doc" now said David breaking Joes train of negative thoughts.

"Show me the report Joe" said Dr White.

Dr White held the strip of paper and rapidly scrolled it forward and then backwards.

"Were you treated for any heart related issue when you were young?" asked Dr White.

"No" said Joe, scared to ask questions.

"Joe, there is a slight aberration in the ECG, it may be nothing to be worry about. To confirm this, I recommend that you get the 128-slice beating heart scan. This the most advanced technology for diagnosis of heart related ailments that is available in the world and we are the only hospital in this city to have this. This gives a clear picture of the beating heart and enables clear diagnosis. And also take a chest X-ray too. I will be available until 1:00 PM, get it done right away and then see me". He wrote down the lab request and handed it over to Joe.

"Hello, I need you to get 128-slice beating heart scan done. How much does it cost? Joe asked the  grim looking gentlemen on the cash counter.

He was shocked at the cost of the hi tech scan, it seemed to have enough digits to max his credit card. Joe looked at David conveying in his look "They are milking us".

Joe realized that the second opinion was going to be expensive and needed to think about this before he went on a diagnostic spree.

Joe was a professional software tester who diagnosed software for defects. He decided to chat with David over a cup of coffee to decide whether to go ahead with the expensive scan. David went to get the coffee while Joe sat down at the corner table, gazing at the birds fluttering over the little pond outside.

During this mindless gaze, staring at the chirpy birds, it suddenly flashed on him, the parallels between his profession and the doctors. In his job, he used black box techniques that required him to examine the system externally and find defects. He relied on deep understanding of the intended behavior, observation of behavior ("symptoms") to design & refine his test cases. He had at times looked at internal information like architecture, technology, code structure to design test cases that were adept at catching issues related to structure.

His colleagues always used terms like "Black box testing" and "White box testing" and associated these to with system and unit levels respectively. Now he realized the general misconception that unit testing was white box testing and system box testing was black box testing. His train of thought was interrupted by hot coffee spilling on his shoulder followed by the shrill sound of glass breaking. "I am really sorry, hope you are ok" said the elderly woman who had tripped over the protruding leg of the gentleman at the neighboring table and spilt the hot cup of expresso that she was carrying. "I am fine, let me help you" said Joe as he helped pick up the glass shreds.

He realized that certain types of defects were better caught via "internal examination"(white box test techniques) while some are most suited to be caught via "external examination" (black box test techniques). He now understood that both of these test techniques were required at all levels to uncover effectively and efficiently.

Suddenly the diagnosis approach followed by Dr Robert Black and Dr James White became clear. As soon as David laid the steaming cup of Cafe Latte on the table, Joe had made the decision. He was not withdrawn or worried. The confidence was back and he would not let the ECG scroll spoil his fun.


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