The Tower of Hanoi

A Torre de Hanói é em um jogo pedagógico simples de complexidade crescente, ilustrativa de um importante campo da psicologia cognitiva chamado de resolução de problemas. Consiste em um método de raciocínio sequencial sustentado por um algoritmo.

                                                                                                                        François Édouard Anatole Lucas (1842 – 1891)

Theophilus's clinical report

(Fictional narrative)*

Theophilus, a 75 year-old-gentleman, always saw the world through a mathematical prism. Previously healthy, his medical care up to this point had been limited to reading the reports of blood tests ordered by his primary care physician, which enhanced his impression that health could be reduced to a game of numbers, with well-defined normal and abnormal boundaries. One of his regular blood tests suddenly showed a high level of PSA (Prostate Specific Antigen). The result could indicate either prostate cancer or benign prostatic hyperplasia, which is a benign enlargement of the prostate.He was baffled by the lack of clarity of the results, which led to a fair amount of disappointment and reinforced his ideas about the lack of scientific rigor in Medicine. His primary care physician explained that more information and further testing would be needed. Fortunately, Theophilus was immediately engaged and asked objective questions to probe his physician's rationale. They eventually agreed to a mutual challenge: the doctor should try to solve the mathematical puzzle called Tower of Hanoi and he would sit through a tutorial that would walk him through the clinical reasoning behind the management of a patient with an elevated PSA. Both were very committed and went on to complete their tasks within 48 hours. The physician understood the world of recursive algorithms and Theophilus accepted medicine as a science of probabilities further stratified into levels of evidence. A line of communication and complicity was created. Theophilus agreed to the proposed tests. He was eventually diagnosed with early stage prostate cancer and his treatment objective was curative.

Abstract 

Overview of the emotional flow and turning points observed in the care of an engineer who bases his life on precise numerical rational calculation. Despite the natural differences between mathematical and probabilistic reasoning, the doctor had to find a creative way to communicate with the patient. Here you will find the plot segmentation, describing how the doctor dealt with the challenges presented by Theophilus's clinical case: The exposition (PLOT 1) occurred in the doctor's office and was directly related to the mutual understanding between doctor and patient about their differences on how to approach problem-solving. The first turning point was based on complicity. The rising action (PLOT 2) was revealed by both patient and physician efforts in meeting the mutual challenge. The conflict (PLOT 3) was a well-documented presentation of their divergent point of views. The climax (PLOT 4) was reached when Theophilus, having understood the medical approach, engaged in shared decision making. During the falling action (PLOT 5) Theophilus had to deal with treatment limitations and toxicity. The second turning point was related to Theophilus ability to overcome the disease, and returning to his previous life style. The resolution (PLOT 6) was presented by the storyteller in a comprehensive biopsychosocial approach.

Emotional Flow

The graph presented below is a simplistic attempt to illustrate the story 2 emotional flow. At each PLOT element the patient-physician relationship creates a tension level along several time intervals (△t). The actions are responsible for the emotional flow, which would be unique for each story, like a digital printing or story DNA. The continuous sine blue wave translates the oscillating patient humor, where the grater inflections represent the turning points. 

*       Attention: The story 2 will be published sequentially from the PLOT 1 to the PLOT 6, however it will appear backwards. So, you will always see the most recent publication. Just browse in numbered pages located at the bottom of the homepage and start to read the story 2 from the beginning. 

To be continued in PLOT 1 (exposition): Equality

© Copyright 2019 Anticancerweb

James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2019

Joao A. de Andrade, MD: Professor of Medicine and Chief Medical Officer, Vanderbilt Lung Institute, Vanderbilt University Medical Center, Nashville, TN – USA 2019 (Associate Editor)