“A symptom tells you where to look. Evidence tells you what to believe. Whether diagnosing a patient or a utility system, trust begins when assumptions end and disciplined investigation begins.” – MJ Martin
Medicine Begins With a Question
After spending a weekend in hospital and watching physicians, nurses, technicians and specialists work through the diagnostic process, it becomes apparent that an emergency department is remarkably similar to a scientific laboratory. A patient arrives with observations called symptoms. The medical team gathers evidence, develops hypotheses, conducts tests, rejects explanations that do not fit the evidence and gradually identifies the most probable diagnosis.
This is essentially the scientific method applied to a human being. The crucial difference is that physicians cannot simply pursue an interesting scientific question. Their first responsibility is determining whether something dangerous is happening right now.
Triage: Establishing the Priority
In Canada, the process commonly begins with the Canadian Triage and Acuity Scale, or CTAS. It categorizes patients from Level 1, resuscitation, through Level 5, non-urgent. Importantly, triage is not diagnosis. It determines how urgently a person requires assessment. The Canadian Association of Emergency Physicians and National Emergency Nurses Association completed a major modernization of CTAS in 2025 to maintain national, evidence-informed standards. (CAEP)
This explains why emergency departments do not operate like the checkout line at Canadian Tire. Patients are not necessarily treated in arrival order. They are prioritized according to clinical risk. CIHI reported 16.1 million Canadian emergency department visits in 2024–2025, with 66 percent classified in the higher-acuity CTAS 1 through 3 categories. (CIHI)
Building the First Hypothesis
Once assessed, the physician begins with the medical history. What happened? When did it begin? What changed? What medications are being taken? What illnesses, surgeries or risk factors already exist?
The physical examination adds another layer of evidence. Heart rate, blood pressure, oxygen saturation, respiratory rate, temperature, neurological status, heart and lung sounds and physical findings begin narrowing the possibilities.
The physician then creates what medicine calls a differential diagnosis. Rather than immediately declaring, “This is the problem,” the physician effectively says, “These are the plausible explanations.”
It resembles troubleshooting a failed electrical system. Before replacing the transformer, an engineer checks the breaker, voltage, connections, loading and upstream supply.
Testing the Hypotheses
Laboratory tests, electrocardiograms, X-rays, ultrasound, CT scans, MRI and other investigations are not normally ordered simply to collect information. Each should answer a clinical question.
A blood test may strengthen one hypothesis while weakening another. Imaging may reveal an abnormality or eliminate a dangerous possibility. A second test may then become necessary because of what the first one revealed.
This is where diagnostic medicine becomes surprisingly mathematical. Physicians continuously revise probabilities. A diagnosis that initially seemed unlikely can become highly probable after one significant test result.
More testing, however, is not automatically better medicine. Choosing Wisely Canada and the Canadian Association of Emergency Physicians specifically caution against unnecessary investigations because tests can produce false positives, incidental findings, radiation exposure and additional procedures without improving patient outcomes. (Choosing Wisely Canada)
Diagnosis Is an Iterative Process
Perhaps the most interesting part of emergency medicine is reassessment. The scientific cycle repeats.
Observe. Hypothesize. Test. Interpret. Treat. Observe again.
A physician may administer medication, oxygen or fluids and then examine how the patient responds. That response itself becomes evidence. Consultants may introduce additional expertise, and new laboratory or imaging results may completely change the working diagnosis.
Emergency medicine therefore deals in probabilities rather than absolute certainty. The objective is often not to explain every abnormality before the patient leaves the emergency department. It is to identify or exclude dangerous conditions, stabilize the patient and determine the safest next step.
CIHI reports that approximately 88 percent of Canadian emergency department visits ultimately result in discharge, while about 12 percent lead to hospital admission. (CIHI)
Science at the Bedside
Watching this process firsthand raises fascinating questions. Should physicians investigate every conceivable possibility, or stop when the evidence establishes a sufficiently reliable diagnosis? How much diagnostic certainty is enough before treatment begins? How should doctors balance the danger of missing a rare disease against the harm of excessive testing?
Perhaps the most important lesson is that modern medicine is not primarily a physician recognizing a disease from memory. It is structured uncertainty management.
The emergency department is, in effect, a scientific laboratory in which the experiment cannot be repeated under perfectly controlled conditions. Every patient arrives with different variables, incomplete information and limited time. The extraordinary achievement of modern Canadian emergency medicine is therefore not that physicians always know the answer immediately. It is that they have developed a disciplined scientific process for finding the answer while simultaneously protecting the patient.
The Utility Industry: Applying the Diagnostic Method
The diagnostic process used in a Canadian emergency department offers an excellent model for decision making in the utility industry. Water, gas and electric utilities also operate complex systems in which the first visible symptom is rarely the complete problem. A sudden increase in water loss, declining AMI read rates, abnormal pressure, communications failures, transformer alarms or unusual customer consumption should therefore be treated much like a medical symptom. It is evidence that something has changed, not necessarily proof of what caused it.
A trusted business practice should begin with observation and triage. Utilities should first determine the severity of the problem and whether it presents an immediate risk to public safety, regulatory compliance, service reliability or financial performance. A suspected gas leak demands a different response than an intermittent meter communication problem, just as chest pain receives a different priority than a minor injury in an emergency department.
The next step should be to develop a differential diagnosis. Rather than immediately blaming the meter, communications network, software platform or customer, the utility should identify several plausible causes. Poor AMI performance, for example, could result from RF propagation, antenna placement, network congestion, endpoint configuration, firmware, backhaul failure, electrical interference or defective hardware. Jumping immediately to one explanation is the utility equivalent of diagnosing a patient before completing the examination.
Testing should then be deliberate. Technical staff can examine interval data, network statistics, pressure information, work-order history, installation photographs, RF measurements and equipment logs. Each investigation should answer a specific question. The objective is not to collect mountains of data. It is to progressively eliminate explanations until the evidence supports the most probable root cause.
Reassessment is equally important. After corrective action is taken, the organization should measure the result. If changing an antenna does not improve communications, the original hypothesis may have been wrong. If pressure reduction produces the expected decrease in leakage, the evidence strengthens the diagnosis. The process continues until the system behaves as expected.
This approach creates something enormously valuable in a utility: institutional trust. Decisions become evidence-based, repeatable and defensible rather than dependent upon instinct, hierarchy or the loudest opinion in the room.
The lesson from medicine is therefore highly transferable. Observe the symptoms, assess the risk, develop competing explanations, test them with evidence, act on the strongest conclusion and then verify the outcome.
In medicine, this discipline protects the patient. In the utility industry, it protects the customer, the infrastructure and ultimately the credibility of the organization.
About the Author:
Michael Martin is the Vice President of Technology with Metercor Inc., a Smart Meter, IoT, and Smart City systems integrator based in Canada. He has more than 40 years of experience in systems design for applications that use broadband networks, optical fibre, wireless, and digital communications technologies. He is a business and technology consultant. He was a senior executive consultant for 15 years with IBM, where he worked in the GBS Global Center of Competency for Energy and Utilities and the GTS Global Center of Excellence for Energy and Utilities. He is a founding partner and President of MICAN Communications and before that was President of Comlink Systems Limited and Ensat Broadcast Services, Inc., both divisions of Cygnal Technologies Corporation (CYN: TSX).
Martin served on the Board of Directors for TeraGo Inc (TGO: TSX) and on the Board of Directors for Avante Logixx Inc. (XX: TSX.V). He has served as a Member, SCC ISO-IEC JTC 1/SC-41 – Internet of Things and related technologies, ISO – International Organization for Standardization, and as a member of the NIST SP 500-325 Fog Computing Conceptual Model, National Institute of Standards and Technology. He served on the Board of Governors of the University of Ontario Institute of Technology (UOIT) [now Ontario Tech University] and on the Board of Advisers of five different Colleges in Ontario – Centennial College, Humber College, George Brown College, Durham College, Ryerson Polytechnic University [now Toronto Metropolitan University]. For 16 years he served on the Board of the Society of Motion Picture and Television Engineers (SMPTE), Toronto Section.
He holds three master’s degrees – in business (MBA), communication (MA), and education (MEd). As well, he has three undergraduate diplomas and seven major certifications in business, computer programming, internetworking, project management, media, photography, and communication technology. He has completed over 80 next generation MOOC (Massive Open Online Courses) [aka Micro Learning] continuous education programs in a wide variety of topics, including: Economics, Python Programming, Internet of Things, Cloud, Artificial Intelligence and Cognitive systems, Blockchain, Agile, Power BI, Big Data, Design Thinking, Security, Indigenous Canada awareness, and more.
Martin is a volunteer, a photographer, a learner, a technologist, a philosophizer, and a romantic optimist.