Dr. Bala Ambati talks about decision-making and action under uncertainty. He reflects on “how doctors think” at a post on his blog. Because that is what they must do above all else. He counsels that counterintuitively, it is sometimes best to do nothing; that “don’t just do something, stand there” is sometimes the optimal solution.
Recently, I attended a “Night for Sight” event where Neil Beidelman, a guide mountaineer, related the events of “Into Thin Air”: in 1996, 8 climbers on Mount Everest died during a storm. When he talked about how a cascade of decisions, decisions that were a bit off but taken in unbelievably challenging moments, “stacked up in the aggregate” and led to the tragic outcome, that really hit home.
As a surgeon, I realized long ago how important it is to minimize mistakes and how it is even more important how you to react to mistakes. Panic and despair make you lose your mental equilibrium and you make further decisions which “stack up” and make the situation worse. . And sometimes no matter what you do, the outcome will not be good or what you want but you do the best you can anyway. …
Pressing for a solution when none is apparent can be the exact wrong thing to do. “Picking up a scalpel and cutting can be just the wrong thing” when you don’t see the whole picture. The good surgeon is not defined by technical dexterity or superior hand-eye coordination, but by sound decision-making and judgment that enable clarity and effectiveness in the operating room. Understanding issues and realizing what intervention can and can’t remedy takes a while to learn in a surgical career; I guess it takes even longer to learn that in life. Groopman, an oncologist, relates one of his mentor’s quips, “Don’t just do something, stand there” as he counsels against the impulse to jump in and do things. It’s awfully hard to do that as a surgeon, who by nature are gamblers, risk-takers who have to have confidence (perhaps arrogance) in what they do.
Of course physicians have long sworn an oath to do nothing when unsure that a procedure would help. After all, they deal in life and death. That would shock many, accustomed as we are to the idea that inaction is always bad. But Hippocratic Oath says in part:
I will not be ashamed to say “I know not,” … If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will not be ashamed to say “I know not” is a phrase rarely heard from the political class. When dealing with a complex organism, such as a human being — or the weather — it is important not to make things worse, since that is a definite possibility. In many situations there may be only right road and many wrong ones. Picking one at random is bad odds. So the doctor reminds himself that “it may also be within my power to take a life” to avoid turning medicine into a floating crap shoot (i.e. “I must not play at God”).
Unfortunately not all advocates are as scrupulous and we often hear about the “precautionary principle” which urges us to spend billions on questionable policies on the off chance that it might save the planet. It could also kill the planet, but nobody mentions that, because somehow “shoot first, ask questions later” is only bad when the wrong people do it. But in reality it is often bad because the null hypothesis is sometimes, even often, true. In certain situations the proposed remedy has no effect except to make things worse, but it would be a good doctor and a bold politician who would publicly advance this proposition. In modern public culture to do nothing is to invite a lawsuit; and so we do something, even if we don’t quite know what we are doing.
Even harder than doing nothing is admitting that you were wrong. It is sometimes possible for people, other than politicians and pundits, to be mistaken. Even doctors. So Dr. Ambati talks about the need for going to Plan B, quoting of all authorities, Batman. “As Bruce Wayne’s father said in Batman Begins, ‘Why do we fall? So we can learn to pick ourselves up.'” When you’re wrong, when you fall, pick yourself up and go to the next option. But with all respect to Batman, sometimes we learn to pick ourselves up, not just to learn but so Godzilla doesn’t catch us. Never mind if we lose our face so long as we don’t lose our pants.
Godzilla has been hard on the heels of Japan lately, which is proud, but not irrational. Recently Reuters reported that “Japan may seek direct U.S. military help to end a crisis at a quake-damaged nuclear power plant in northeastern Japan, the chief government spokesman said on Wednesday.” No details were given. The Straits Times carries the same story, but it appears to be nothing except an acknowledgement that past and future cooperation will take place. Boing-boing however, quotes an Asahi story suggesting that the US contributed damage control assets to containing the fire at one reactor.
The natural source of such assistance would be the Navy, which operates reactors at sea and may have damage control procedures for fixing equipment wrecked by combat or accident. Or it might be the Army which has acquired extensive experience at using robotic vehicles to defuse and clear bombs. Or they may require equipment different from the industrial robots designed to perform routine inspection and repair on nuclear power plants. In ad hoc situations, a robot combat engineering vehicle that “can be equipped with buckets, blades, cutters, arms” may be more useful. One such vehicle is the ACER.
And if Plan B fails then the Japanese engineers will doubtless go to Plan C, Plan D and so on until they either get away from Godzilla or the big scaly monster catches them. Although their disadvantages have been greatly exaggerated, the great thing about being an engineer solving a problem is that you can do nothing when you don’t know what to do or change your mind when your initial plan fails. That these are acceptable options makes it possible to fix the actual problem. As Ronald Reagan once said, “there is no limit to what you can accomplish if you don’t care who gets the credit.” Or the blame.
Unfortunately the option to do nothing or admit error is an course that is rarely available to those in public life. Maybe the biggest problem with modern political culture is that unlike the profession of medicine, politicians take no Hippocratic Oath. Unlike doctors, officials can never say, “I know not”, except when explaining the presence of cash in the kitchen freezer. Moroever, they must at all times never be wrong, or having been wrong vary a jot or tittle from their announced course. One would hope that in time politicians would become more like doctors, though sadly, in all probability the reverse is true. Maybe in the end all of us will become like politicians. Yet even there some hope remains.
“No Way In” print edition at Amazon
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