Henry Petroski’s Success Through Failure: The Paradox of Design argues for the optimistic view of mistakes in examples such as bridge design, tall building architecture, bicycle lock design, and NASA’s Challenger tragedy. Over and over again, Petroski shows how success teaches us very little and failure teaches us a lot. The creed at IDEO, the famous design company, is “Fail early, fail often.” Professor Jack Matson believes so strongly in the role of failure in design that he expects students in his Innovative Engineering Design course at Penn State University to fail in order to pass.
“Innovation requires that you go beyond the known into the unknown, where there might be trap doors and blind alleys. You’ve got to map the unknown. You map it by making mistakes.”
What really got me thinking about error in a new way was Schulz’s treatment of illusions. I was already familiar with the two faces/vase and old woman/young woman visual illusions, but I was blown away by Scottish explorer John Ross discovering the illusory Croker Mountains in Lancaster Sound and American Robert Peary who saw a mirage of an entire continent in northern Canada. Although Ross’ illusion ruined his career, our usual response to illusions is amusement and wonder. Illusions really do upend our conventional reaction to being wrong.
This amazing book by Schulz made me think about life in a new way. Her thoughts on St. Augustine, Dadaism, zealotry, groupthink, Ben Franklin, and the Talmud convince me that to be human is to make mistakes. Just one example: according to the Talmud, “if there is an unanimous guilty verdict in a death penalty case, the defendant must be allowed to go free – a provision intended to ensure that, in matters so serious that someone’s life is on the line, at least one person has prevented group think by providing a dissenting opinion.”
In The Invisible Gorilla: And Other Ways Our Intuitions Deceive Us Christopher Chabris and Daniel Simons expanded my appreciation for humans making mistakes by explaining the brain’s illusion of knowledge. Examples include the world’s leading geneticists predicting that humans have between 25,747 to 153,478 genes when the right answer is 20,500. Leon Rozenblit and Frank Keil did dozens of experiments which all showed that we are “blissfully unaware of the shortcomings in our own knowledge.” For example, The Big Dig in Boston cost 250% more than originally planned because the civil engineers thought they knew more than they really did about putting streets underground. The authors also remark that our illusions all tend to cast an overly favorable light on human mental capacities. “There are no illusions of blindness, amnesia, idiocy, and cluelessness.” Later in this blog, we will see they may be wrong here. It is also sobering to note that people with depression are said to have a more accurate view of their relationship to reality than others who are not depressed.
I zeroed in on Jonah Lehrer’s treatment of mistakes in How We Decide, and I think Schulz would be happy with his effort. Bill Robertie, a world-class expert at chess, poker, and backgammon, claims that the way to improve is to focus on mistakes. The famed physicist Niels Bohr defines an expert as “a person who has made all the mistakes that can be made in a very narrow field.” I was impressed by Carol Dweck’s studies at Stanford that showed that praising students for their intelligence resulted in worse performances than praising students for their effort. However, I was most impressed by the story of Michael Riley of the Royal Navy and how he used his intuition to correctly differentiate a silkworm missile from a friendly airplane by listening to his intuition and his dopamine receptor.
Since mistakes are such a central part of human life, one would think we would get really good at apologizing. Think again. Lisa Belkin nicely summarizes how difficult it is for us to say sorry sincerely. Although apologies are “the most profound of human interactions” that can heal and resolve guilt and anger, some now see many non-apology apologies that do not satisfy either the sinner or the victim. Think recent apologies by Tiger Woods or BP’s Tony Hayward. Or maybe an even better example of non-apology apologies is GOP Congressman Joe Barton apologizing to BP and then apologizing for apologizing to BP.
According to Belkin, some states have passed laws making a doctor’s apology inadmissible as evidence in a lawsuit, in the belief that patients find solace when a doctor admits a mistake, and that doctors are more likely to do so if they are taking part in a conversation and not a confession. “These laws might well free doctors to speak more honestly with patients and families and allow for a chance to truly repair their relationship. Or they might have the opposite effect entirely. With less at stake for the doctors, could apologies become pro forma and, as a result, less powerful?”
My friends, family, and co-workers were getting tired of me raving about the above four books, when I stumbled upon something even more mind boggling: Errol Morris’ The Anosognosic’s Dilemma: Something’s Wrong but You’ll Never Know What It Is (Parts 1-5).
This article ricochets from Donald Rumsfeld to McArthur Wheeler (a hapless bank robber who thought lemon juice would make him invisible) to the famed neurologist Joseph Babinski to President Woodrow Wilson to Marcel Proust to surrealism. The starting point is the Dunning-Kruger Effect which was described in a landmark article titled “Unskilled and Unaware of It: How Difficulties of Recognizing One’s Own Incompetence Lead to Inflated Self-assessment.”
Anosognosia (from the title of the Morris article) is a condition in which a person who suffers from a disability seems unaware of or denies the existence of his or her disability; it was first described by Babinski in patients who were paralyzed but refused to acknowledge their problem.
Morris thinks deeply and creatively about “known unknowns,” “unknown unknowns,” and “unknowable unknowns.” In interviewing David Dunning, he discusses how the mediocre doctor is not aware of diagnostic possibilities and treatments that he never considers. More disturbing is a study of medical students which shows that those at the bottom of the class cannot learn by being shown what the smart students are doing to progress along the Dreyfus model of competence. They are like McArthur Wheeler who was too stupid to know that he was too stupid to successfully rob banks.
Morris’ epilogue states
I have to admit my fondness for the Dunning-Kruger Effect. But is it a metaphor for existence? For the human condition? That we’re all dumb and delusional? So dumb and delusional that we can never grasp that fact? It’s so profoundly depressing and disturbing. Even sad. Dunning gives us no hope. The McArthur Wheelers of this world will never understand their limitations. But aren’t we all McArthur Wheelers?
I think we are all McArthur Wheelers, but I am comforted by V. S. Ramachandra’s observation that
“It may well be our brains are wired up to be slightly more optimistic than they should be.”
For any physician to be a master diagnostician he or she must learn from mistakes and also be acutely aware of what they know they don’t know. They must also admit that some things about people and their ailments are just unknowable. Making mistakes does not make you a bad doctor or a bad person. Making mistakes makes you a human being. Get used to it. And learn how to apologize sincerely. You might want to read On Apology by Aaron Lazare, MD. I just did, and I have a lot of work to do.
Now, if EVERY doctor will just admit that they do not know everything and that they are willing to learn from our children who are defying the odds against them... I would look forward to every doctors appointment!! In the meantime, I'll take the oldies because maturity seems to bring about honesty :) Needless to say, these "professionals" could learn a lot from us mommies of medical miracles...