I have taken to watching a show on, I believe the Discovery Channel or maybe Discovery Health?, called Mystery Diagnosis. The idea is simple: it tells the true story of someone with a disease for which they had trouble getting a correct diagnosis, but then eventually they either talk to the right person or get the right information to find out what the problem is. In many cases, they've needlessly endured a treatable illness or condition for years, and the resulting diagnosis and treatment is life-changing. It's a feel good program, but it raises a lot of critical issues.

I've noted a few recurring themes in the program:

• Almost invariably, the sufferer is given a cursory diagnosis that, at least in hindsight, appears to match their observed symptoms extremely poorly. Often friends and family members are extremely frustrated by the failure to dig deeply into the illness, while the patient is often oddly satisfied by the explanation despite their ongoing suffering.
• The "mystery" is often not very mysterious at all once a doctor cares to take a serious look at the problem. In one recent episode, the initial doctor repeatedly dismisses a man's massive adominal pain and horrific bleeding as "bad hemorrhoids". After the man switches insurance and is essentially forced to see a different doctor because of network coverage changes, he is immediately given a full colonoscopy which reveals stage III colon cancer. That's far from a "mystery" diagnosis and more like massive malpractice by the initial doctor.
• The succesful doctor usually solves the mystery by using a combination of careful inspection of the patient conditions, listening and really trusting the patient's self-reported problems, targeted diagnostics, and reasoning about pathology. Once a careful catalog is made of the issues, history, and some simple bloodwork, the problem is almost always fairly obvious.

I can't help draw parallels to my experience diagnosing software failures. A mysterious problem often turns out to be fairly obvious when the symptoms are actually catalogued and investigated, and there are often one or more "experts" who have come up with a variety of hypotheses, none of which seem to match the available facts. In the world of medicine, certainly the stakes are much higher, but a serious software bug can still cost dozens of companies hundreds of hours in downtime or lost productivity. I wonder the same thing about both medicine and software: what will it take for the field to decide to get better at diagnosis?