Yes, there will be math
Knowing numbers can be useful and even fun
At first glance, “Take two pills and call me in the morning” is about the extent of math in medicine. More than a few doctors would agree.
“A few years ago, I was in a restaurant with fellow doctors for dinner,” said Dr. Jaifred F. “Jim” Lopez. “After receiving the bill, my friends started to pay with their thousand-peso bills.
“Bewildered with the prospect of having to compute the change due to every single person in that dinner, I said with much exasperation, ‘This is why I’m a doctor, I’m not good at math,’” he said.
Lopez teaches epidemiology at the College of Public Health, University of the Philippines Manila. He also does research in health policy and management. Years later, he accepted that math can be useful, “even fun.” In fact, he has become enamored with statistical programming.
It figured he would talk with colleagues about how they chose their careers based on math skills — or lack of them.
Ourlad Tantengco is a premed student at the University of the Philippines Diliman where he must study algebra, trigonometry and differential and integral calculus.
“As health professionals, we don’t need to be math or statistics experts,” he said. “Basic knowledge will do. If you have difficulty in them, consult math or stats experts. That’s the problem with some researchers. They only consult after the experiments.
“I attended a residents’ proposal defense last semester,” Tantengco said. “I had a lot of comments and suggestions for the statistical analyses to be used for their clinical research. I think even doctors still have confusion with statistics.”
Lopez had no such confusion, although he might have surprised himself with his eventual career path.
“My original career choice was computer science — definitely a math-based one,” he said. “At the time, I only wanted to create stunning web pages. I didn’t realize that a lot of math should go with it. I only realized it in college.
“While fate led me to medicine — I qualified for an accelerated medicine program — my interest in math resurfaced as a researcher,” Lopez said. “Now I rekindle a love for programming.”
Calculating on calculus
Admittedly, he did not do well in algebra and trigonometry, but calculus gave Lopez hope.
“Not exactly excellent, but I was surprised,” he said. “It turns out that the calculus skills were the ones that mattered for me. Statistics came afterward.”
His reliance on math has taken on greater importance in his career.
“We have to interpret things right,” Lopez said. “Lives and communities hang in the balance.”
Dr. Chuck Webster describes himself as “an industrial engineer who went to medical school.” He makes the Robot-In-My-Pocket 3D-printed talkative pocket-protector robot for pediatricians. He also hosts the Health Systems Chat that specializes in social virtual reality.
“I had good enough math skills for management science and operations research, but not physics or electrical engineering,” he said. “I ended up getting a degree where I met my math competency ceiling: industrial engineering. That said, I greatly enjoyed the challenge.
“Could I now crank through equations I ‘mastered’ 30 years ago? Hardly — at least not without a lot of study,” Webster said. “However, qualitative ideas behind them — power of matrices, evaluation functions over complex systems, global versus local optima, regression to the mean — are invaluable.”
Dr. Helen Madamba knows math shyness is not confined to doctors. She is an obstetrics-gynecology infectious disease specialist at Vicente Sotto Memorial Medical Center in Cebu City, the Philippines.
“Even when teaching research, medical students and faculty alike get intimidated by statistics,” she said. “Numbers are not the only important thing in research. The stories that people tell is essential data as well.
“We had a meeting with chiefs of hospitals in the region,” Madamba said. “We presented maternal and perinatal statistics — numbers — but it was the deaths of 14- and 16-year-old pregnant teenagers that got our attention. Time to get up and act.”
Still prime numbers
Math skills retain their importance in the doctor’s current practices.
“I do research for a living and for fun,” Lopez said. “While most of the research I’m doing is qualitative, I have to review articles where I am to judge the statistical significance of results and see how this should impact health policy.
“Recently, I was given another challenge: Teach epidemiology in college and graduate school,” he said. “That’s putting math skills at a whole new level. I’m excited to dive in.”
Using apps eases some of the math burden. Lopez thinks that’s a mixed blessing.
“While apps help healthcare providers make decisions fast, they contribute to a blunting down of our math and analysis skills,” he said. “This still needs to be studied, though.”
Madamba prefers stories to tell the tale, yet knows numbers crystallize facts.
“Our medical director always asks me for statistics,” she said. “They’re the basis for administrative decisions. Numbers help us monitor our progress and show improvements in systems toward reducing maternal mortality.
“My research class is more of a writing class than a math class,” she said. “I’m glad I have the help of statisticians and psychometricians to help churn up the numbers, which we will interpret. Every year, we are expected to submit annual statistics.”
Mystical names
Tantengco knows where to turn for help, which is good for crunching numbers. Just the names of the processes would mystify a layman.
“I have several biostatistician friends,” he said. “I always consult them when I really don’t know how to perform the statistical analysis such Kaplan Meier Analysis and multinomial logistic regressions.
“We need to be cautious in interpreting statistical significance,” Tantengco said. “Sometimes, biostatisticians can do their magic to influence the results of experiments to favor the result the researchers want.”
He primarily uses statistics to compute sample size for human papillomavirus and cervical cancer research.
“Hand computations have their place, and the app in another,” Lopez said. “For training purposes, it’s nice to do calculations by hand, especially if we are to teach the principles. For everything else, apps will help.
“Most of us use math in epidemiology and statistics, others in clinical uses — drip rates, drug doses,” he said. “We also remember its utility in analyzing test results. We rely on math more than we realize.”
To improve math skills in training health professionals, teachers as far back as elementary school need to relate and emphasize the importance of math. It can’t be seen as a square filler that you’ll never use again. Knowing math is essential might help open the mind to learning.
“You have to use it,” Madamba said. “Otherwise, you lose it. We have apps to compute, but we need to know how to compute the hard way in case our gadgets are empty battery.”
Lopez offered these math tips:
- Whenever I have to explain something complex — even in health policy — representing them as equations does the trick.
- When adding simple numbers, do mental math.
- Use pictorial models — like Singapore Math — for estimating. This is for mental math, of course.
- Always be conscious of decimal points: the deadliest math error.
“Face your fears,” Tantengco said. “They’re just numbers. You can befriend them and use them to your advantage. It’s difficult at first, but you will get used to it.
“There are a lot of seminars and short courses on biostatistics,” he said. “Consult your friendly biostatisticians.”
Love it or hate it, there is no way around math in healthcare.
“Math is the language of analysis,” Lopez said. “Since we make crucial decisions that affect the lives of patients and communities, we must take math seriously in training.”
About The Author
Jim Katzaman is a manager at Largo Financial Services and worked in public affairs for the Air Force and federal government. You can connect with him on Twitter, Facebook and LinkedIn.
