The Failure of Myth and the Future of Medical Mistakes

 

Please note: this is another chapter in a series of blog posts about Failures in Foresight. You may want to also read the other blog posts dealing with the Failure of Nerve, the Failure of the Paradigm, and the Failure of Segregation.

 

At the 1900 World Exhibition in Paris, French artists made an attempt to forecast the shape of the world in 2000. They produced a few dozens of vivid and imaginative drawings (clearly they did not succumb to the Failure of the Paradigm!)

Here are a few samples from the World Exhibition. Can you tell what all of those have in common with each other?

military-cycles-what-1900-french-artists-thought-the-year-2000-would-look-like.jpg
Police motorcycles in the year 2000
skype-what-1900-french-artists-thought-the-year-2000-would-look-like.jpg
Skype in the year 2000
phonographs-what-1900-french-artists-thought-the-year-2000-would-look-like.jpg
Phonecalls and radio in the year 2000
birding-what-1900-french-artists-thought-the-year-200-would-be-like.jpg
Fishing for birds in the year 2000

 

Psychologist Daniel Gilbert wrote about similar depictions of the future in his book “Stumbling on Happiness”

“If you leaf through a few of them, you quickly notice that each of these books says more about the times in which it was written than about the times it was meant to foretell.”

You only need to take another look at the images to convince yourselves of the truth of Gilbert’s statement. The women and men are dressed in the same way they were dressed in 1900, except for when they go ‘bird hunting’ – in which case the gentlemen wear practical swimming suits, whereas the ladies still stick with their cumbersome dresses underwater. Policemen still employ swords and brass helmets, and of course there are no policewomen. Last but not least, it seems that the future is entirely reserved to the Caucasian race, since nowhere in these drawings can you see persons of African or Asian descent.

 

The Failure of Myth

While some of the technologies depicted in these ancient paintings actually became reality (Skype is a nice example), it clear the artists completely failed to capture a larger change. You may call this a change in the zeitgeist, the spirit of the generation, or in the myths that surround our existence and lives. I’ll be calling this A Failure of Myth, and I hope you’ll agree that it’s impossible to consider the future without also taking into account these changes in our mythologies and underlying social and cultural assumptions: men can be equal to women, colored folks have rights similar to white folks, and people of the LGBT have just the same right to exist as heterosexuals. None of these assumptions would’ve been obvious, or included in the myths and stories upon which society is bases, a mere fifty years ago. Today they’re being taken for granted.

 

1013px-USMC-09611.jpg
The myth according to which black people have very few real rights was overturned in the 1960s. Few forecasters thoguht of such an occurence in advance.

 

Could we ever have forecast these changes?

Much as in the Failure of the Paradigm, I would posit that we could never accurately forecast the future ways in which myths and culture is about to change. We could hazard some guesses, but that’s just what they are: a guesswork that relies more on our myths in the present, than on solid understanding of the future.

That said, there are certain methodologies used by foresight researchers that could help us at least chart different solutions to problems in the present, in ways that force us to consider our current myths and worldviews – and challenge them when needed. These methodologies allow us to create alternative futures that could be vastly different from the present in the ways that really matter: how people think of themselves, of each other, and of the world around them.

One of the best known methodologies used for this purpose is called Causal Layered Analysis (CLA). It was invented by futures studies expert Sohail Inayatullah, who also describes case studies for using it in his recent book “What Works: Case Studies in the Practice of Foresight”.

In the rest of this blog post, I’ll sum up the practical principles of CLA, and show how they could be used to analyze different issues dealing with the future. Following that, in the next blog post, we’ll take a look again at the issue of aerial drones used for terrorist attacks, and use CLA to consider ways to deal with the threat.

 

Mines_1.jpg
Another Failure of Myth: the ancient Greek could not imagine a future without slavery. None of their great philosophers could escape the myth of slavery. Image originally from Wikipedia

 

 

CLA – Causal Layered Analysis

The core of CLA the idea that every problem can be looked at in four successive layers, each deeper than the previous one. Let’s look at each layer at its turn, and see how each layer adds depth to a discussion about a certain problem: the “high rate of medical mistakes leading to serious injury or death”, as Inayatullah describes in his book. My brief analysis of this problem at every level is almost entirely based on his examples and thoughts.

First Layer: the Litany

The litany is the day-to-day talk. When you’re arguing at dinner parties about the present and the future, you’re almost certainly using the first layer. You’re basically repeating whatever you’ve heard from the media, from the politicians, from thought leaders and from your family. You may make use of data and statistics, but these are only interpreted according to the prevalent and common worldview that most people share.

When we rely on the first layer to consider the issue of medical mistakes, we look at the problem in a largely superficial manner. We can sum the approach in one sentence: “physicians make mistakes? Teach them better, and if they still don’t improve, throw them to jail!” In effect, we’re focusing on the people who are making the mistake – the ones whom it’s so easy to blame. The solutions in this layer are usually short-term solutions, and can be summed up in short sentences that appeal to audiences who share the same worldview.

Second Layer: the Systemic View

Using the systemic view of the second layer, we try to delve deeper into the issue. We don’t blame people anymore (although that does not mean we remove the responsibility to their mistakes from their shoulders), but instead we try to understand how the system itself can contribute to the actions of the individual. To do that we analyze the social, economic and political forces that meld the system into its current shape.

In the case of medical mistakes, the second layer encourages us to start asking tougher questions about the systems under which physicians operate. Could it be, for example, that physicians are rushing their treatments since they are only allowed to talk with each patient 5-10 minutes, as is the custom in many public medical services? Or perhaps the shape of the hospital does not allow physicians to consult easily with each other, thus reaching more solid solutions via teamwork?

The questions asked in the second layer mode of thinking allow us to improve the system itself and make it more efficient. We do not take the responsibility off the shoulders of the individuals, but we do accept that better systems allow and encourage individuals to reach their maximum efficiency.

Third Layer: Worldview

This is the layer where things get hoary for most people. In this layer we try to identify and question the prevalent worldview and how it contributes to the issue. These are our “cognitive lenses” via which we view and interpret the world.

As we try to analyze the issue of medical mistakes in the third layer, we begin to identify the worldviews behind medicine. We see that in modern medicine, the doctor is standing “high above” in the hierarchy of knowledge – certainly much higher than patients. This hierarchy of knowledge and prestige defines the relationship between the physician and the patient. As we understand this worldview, solutions that would’ve fit in the second layer – like the time physicians spend with patients – seem more like a small bandage on a gut wound, than an effective way to deal with the issue.

Another worldview that can be identified and challenges in this layer is the idea that patients actually need to go to clinics or to hospitals for check-ups. In an era of tele-presence and electronics, why not make use of wearable computing or digital doctors to take care of many patients? As we see this worldview and propose alternatives, we find that systemic solutions like “changing the shape of the hospitals” become unnecessary once more.

Fourth Layer: the Myth

The last layer, the myth, deals with the stories we tell ourselves and our children about the world and the ways things work. Mythologies are defined by Wikipedia as –

“a collection of myths… [and] stories … [that] explain nature, history, and customs.”

Make no mistake: our children’s books are all myths that serve to teach children how they should behave in society. When my son reads about Curious George, he learns that unrestrained curiosity can lead you into danger, but also to unexpected rewards. When he reads about Hensel and Gretel, he learns of the dangers of trusting strangers and step-moms. Even fantasy books teach us myths about the value of wisdom, physical prowess and even beauty as the tall, handsome prince saves the day. Myths are perpetuated everywhere in culture, and are constantly strengthened in our minds through the media.

What can we say about medical mistakes in the Myth level? Inayatullah believes that the deepest problem, immortalized in myth throughout the last two millennia, is that “the doctor knows best”. Patients are taught from a very young age that the physician’s verdict is more important than their own thoughts and feelings, and that they should not argue against it.

While I see the point in Inayatullah’s view, I’m not as certain that it is the reason behind medical mistakes. Instead, I would add a partner-myth: “the human doctor knows best”. This myth is spread to medical doctors in many institutes, and makes it more difficult to them to rely on computerized analysis, or even to consider that as human beings they’re biased by nature.

 

Consolidating the Layers

As you may have realized by now, CLA is not used to forecast one accurate future, but is instead meant to deepen our thinking about potential futures. Any discussion about long-term issues should open with an analysis of those issues in each of the four layers, so that the solutions we propose – i.e. the alternative futures – can deal not only with the superficial aspects of the issue, but also with the deeper causes and roots.

 

Conclusion

The Failure of Myth – i.e. our difficulty to realize that the future will not only change technologically, but also in the myths and worldviews we hold – is impossible to counter completely. We can’t know which myths will be promoted by future generations, just as we can’t forecast scientific breakthroughs fifty years in advance.

At most, we can be aware of the existence of the Failure of Myth in every discussion we hold about the future. We must assume, time after time, that the myths of future generations will be different from ours. My grandchildren may look at their meat-eating grandfather in horror, or laugh behind his back at his pants and shirt – while they walk naked in the streets. They may believe that complicated decisions should be left solely to computers, or that physical work should never be performed by human beings. These are just some of the possible myths that future generations can develop for themselves.

In the next blog post, I’ll go over the issue of aerial drones use for terrorist attacks, and analyze it by using CLA to identify a few possible myths and worldviews that we may need to change in order to deal with this threat.

 

Please note: this is another chapter in a series of blog posts about Failures in Foresight. You may want to also read the other blog posts dealing with the Failure of Nerve, the Failure of the Paradigm, and the Failure of Segregation.

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