Diagnosis Solves Medical Mysteries

Health Care Problems Are Mysteries, Not Puzzles, Says Bestselling Author

ANAHEIM, Calif. – November 12, 2016 -- “The great challenge of the 21^st century is to reorient ourselves to solving mysteries,” Malcolm Gladwell, five-time New York Times bestselling writer and staff writer for The New Yorker, said here at the plenary session during the American Academy of Optometry annual meeting.

Gladwell said a transformation is occurring in problem solving – a shift from problems based on puzzles, where finding more information is key, to mysteries, which are defined by making sense of all available information.

The theory stems from Gregory Treverton, PhD, MPP, chairman of the National Intelligence Council, he explained.

To illustrate a puzzle, Gladwell used the Cuban Missile Crisis from 1962 as an example.

In the summer of 1962, the Central Intelligence Agency (CIA) observed Russia sending more than 30 ships to Cuba and unloading cargo. The CIA sent a plane to take photographs of the cargo, which made the agency confident that the cargo was missiles pointed at the U.S., Gladwell said.

“Think about that problem from the CIA’s perspective,” Gladwell proposed. “They questioned whether their enemies were up to something and they didn’t know what it was, so they went out to gather data to find what the problem was. The data gave them a clear example of what the problem was.”

A puzzle is a problem you solve by gathering more information, he said.

In the case of Sept. 11, 2001, the opposite was happening, he said.

With the Cuban Missile Crisis, the solution was to gather more information. With 9/11, we already had the information; the U.S. government knew al Qaeda was preparing something for the fall, he said.

“The task in this case was not gathering information on something we didn’t know enough about, it was making sense of the plethora of information that we already had,” he said.

Based on Senate reports, Gladwell read that the Federal Bureau of Investigation had 66,000 researched terrorist leads in the summer of 2001.

“They couldn’t find the message in all of the noise,” he said. “It is profoundly different from the problem we faced with the Cuban Missile Crisis.”

Treverton says you cannot solve a problem unless you know what category it belongs in, Gladwell added.

Our world has been designed to solve puzzles, he said.

“When we train professionals or build schools of medicine, business or law, they have all been set up based on the expectations that the problems professionals will face can be solved by puzzles, but the world we are living in isn’t a puzzle world anymore, it’s a mystery world,” he said. “The world of health care has failed to appreciate the meaning of this shift from puzzle to mystery.”

Electronic health care records, for example, equate to doctors now having to spend more time at a computer instead of having more time to establish trust with their patients, he said, and the concern for time is a big one.

The average patient visit has stayed the same as it was decades ago, he said, “which is crazy, because the number of things that need to be discussed has grown exponentially. Treatments have increased, information on diseases and conditions has [grown] and now patients are armed with more information, so you can’t have a simple conversation anymore, you have to have a complex one.”

The pressure from those outside of the industry to standardize care with a one-size-fits-all model represents the puzzle world, while patients, science and medicine are pushing for quality care, from an individualized model of the mystery universe, he said.

“We have a world that is insisting increasingly that health care is a puzzle, and then we have health care itself, which is realizing that it is a mystery. These two things are in conflict,” he said.

“I feel this way as a patient,” he continued. “What I want is the time, attention, care and judgment of a person with whom I’m sharing the most intimate details of my life. I don’t want someone just checking a box. I want an understanding of the nature of the problems.”

He said that to reshape the health care system, we must all speak up. –by Abigail Sutton

Reference:

Gladwell M. Current state of health care and research. Presented at: American Academy of Optometry annual meeting. November 8-13, 2016; Anaheim, Calif.

Disclosure: Gladwell is the author of five New York Times bestsellers and has been a staff writer for The New Yorker since 1996.

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