From ignorance to ineptitude [Parrish/Gawande]
The article mentions an older paper, by two philosophers, Samuel Gorovitz and Alasdair MacIntyre who in the 1970s published a short essay called “Towards a Theory of Medical Fallibility”.
In the essay they make a distinction between two types of failure:
- Ignorance — we may err because science has given us only a partial understanding of the world and how it works.
- Ineptitude — the knowledge exists, yet we fail to apply it correctly.
Gawande then makes a couple of super interesting observations:
1 . For most of history, we’ve failed because of ignorance… [however] over the last several decades our knowledge has improved. This advance means that ineptitude plays a more central role in failure than ever before.
2. Failures [of ineptitude] carry an emotional valence that seems to cloud how we think about them. Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.
Parrish fleshes out #1 in a bit more details:
Today there is more to know, more to manage, more to keep track of. More systems to learn and unlearn as new ones come online. More emails. More calls. More distractions. On top of that, there is more to get right and more to learn. And this, of course, creates more opportunity for mistakes.
Our typical response, rather than recognising the inherent complexity of the system by which judgments are made, is to increase training and experience.
Gawande’s solution to the challenge is to do a better job in capturing the critical know-how through checklists.
But on a deeper level, I think that to make meaningful progress, we’d need to decouple failures of applying (“known”) knowledge from automatic judgment, at least initially. Not all of these failures are inherently blame-worthy. If we are to learn from these failures and improve, compassion may be a better emotion to start with.