The Illusion of Control

Medicine is not an exact science. There is a large component of art in the practice of medicine, but those who would control the practice of medicine would like you to believe differently. There’s an underlying assumption that if physicians simply followed rules better, the practice of medicine would become safer, cheaper, and better.

This is a delusion.

I’ve written about the difference between right brain and left brain thinking in several previous posts, and how that relates to the practice of medicine. The art of medicine requires right brain thinking.

Right brain thinking doesn’t follow rules as much as it relies upon recognizing a correlation between the present symptoms (often visual) in front of the physician and a similar visual appearance, possibly of only one occurrence as long as 30 years before.

“Evidence-based” medicine instead relies upon counting repeated occurrences of items which can be forced into a written phrase, an item on a checklist.

Shirie Leng on her blog Medicine for Real, captures this contradiction very well in her post “NOT Blinded by Science“:

 The field attracts a completely different type of person to do a completely different job than was originally practiced by doctors.  True, we can actually do useful things to help people now.  We can do those things thanks to the contributions of the scientific community, into which medicine has been subsumed.  But medicine, from it’s roots, is about caring for people.

The North Dakota Legislature’s attempts to deliberately stir the waters by resorting to some very unscientific notions about fetal life illustrates the kinds of problems which arise when those who wish to control try to define what they are determined to stamp out.  Douglas Hofstadter, in  provides a good description of this kind of control mentality:

Reductionism is the most natural thing in the world to grasp. It’s simply the belief tht “a whole can be understood completely if you understand its parts, and the nature of their ‘sum.’” No one in her left brain could reject reductionism.

Indeed, there are those who study law, and the making of laws, from the perspective of reductionism. Steven D. Smith in “Reductionism in Legal Thought” surveys the effect of this kind of thinking in the production of laws.

The last 30 years have seen tremendous growth in our understanding of complexity, including understanding about our inability to control every iota of a process. Called by various names, , or the theory of complexity, the overriding issue is that changes introduced into complex systems produce results which we cannot anticipate, much less control in a reductionist manner.

Which yes, does lead back to the notion by opponents of abortion that if a law can be described in enough detail, the law will cover all possible outcomes, and the desire of those thinking in these terms, banish abortion entirely from the face of the earth.

We know from studies of complexity that drafting such a law is impossible.  But legislators, prodded by the segment of voters the politicians think control their elected seats, attempt to provide in legislation what is impossible to provide. But the legislators and those left-brain thinkers who slice up the human experience into checklists ignore reality. In North Dakota, these legislators excuse themselves on the basis that they represent the majority of voters.

Not true.  What they represent is that the state of North Dakota, in this legislative session, clearly has elected enough Republicans to outvote Democrats. Steve Andrist, in “North Dakota’s Most Conservative Legislative Session?” surveys the depth of this conservative shift:

In the final analysis, the decisions on whether spending is sufficient or deficient, whether tax cuts are appropriate or generous, whether social issues are important or an intrusion, will be made by the majority party.

It is perhaps safe then to say that the controlling Republican party in the North Dakota legislature has for the first time in many years been successful in passing legislation steeped in reductionist thinking.

The kind of thinking propelled by a feeling of power and the illusion of control.

 

dhaugen
Some young HR person once looked at my CV and asked me, quite seriously, if I had really done everything I had listed there. Well, yes. Because I am someone who can't sit in a Morris Miller cubicle every day, much less for any great stretch of time. Once the problem is solved, I get bored and I'm ready to move on to the next challenge. This hasn't afforded me any great stability in my work life. I simply arrive in places about ten years ahead of time. So far, at least, that penchant for early arrival hasn't been accompanied with a pocketbook full of door knobs.
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