Book Review: Nonsense, The Power of Not Knowing

Ambiguity, uncertainty, lack of closure: whatever you want to call it, the world is rife with situations and challenges that simply can't be neatly categorized, wrapped up, or controlled. How we perceive, understand and respond to these types of situations plays a critical role in determining whether we succeed or fail in everything – art, business, politics, relationships. More often than we think, it can mean the difference between life and death. It's no secret that some people handle ambiguity better than others and, in Nonsense, author Jamie Holmes explores why that is, and what all of us can do to improve our relationship with life's uncertainties.

This book has a lot going for it. The author found some very interesting stories and examples to illustrate his points all along the spectrum, from puzzles and Mad Libs on the frivolous side of things to hostage negotiations at the extremely serious end of the spectrum. Often the writing was clear, sharp and fluid – very much a pleasure to read. It was meticulously edited.

Unfortunately, the book was not uniformly strong. In several places the narrative seemed to inexplicably get lost, meandering or segway-ing jerkily from one point to another. For some reason I never quite figured out, it also seemed to be a difficult book to keep one's head in. Every time I set it down, it would take a minute to remember where I was and what was being discussed when I picked it up again. It really didn't stick or linger the way I would have expected from a book about such a relevant subject. I couldn't help but feel that the “application” part would have decidedly benefited from a different approach as well; an alternate format might have made it easier to walk away feeling like I'd learned practical things I could effectively apply to improving my own ability to handle ambiguity other than just being more aware of it.

All things considered, it's a solid book and worth reading for the impact and thought-provoking qualities of it's strong portions. 

I received this book from the Blogging for Books program in exchange for this review. As always, my opinions are my own.

Common Core: Medical Edition

They say that measurement is the first step towards controlling and improving things, and that “you are what you measure”. Management dogma has long promoted intensive measurement, tracking and reporting as the main driver of desired change.

Unfortunately, as the Common Core debacle has demonstrated, any attempt to apply this theory to practice will see it quickly erode in the face of two inconvenient realities. First, critical and relevant aspects of a situation are often intangible; they simply don't lend themselves to effective and accurate measurement. Second, no matter what you're looking at, there are almost always scores of contributing and/or influential factors, making it almost impossible to measure, aggregate, and report on them in a meaningful way. Considering that some of those factors will be several steps removed from the “main action” and/or intangible, and you've got a clear recipe for frustration!

Why am I rambling at you about this business nonsense? Because it's exactly what came to mind when I read that “non-profit news outlet ProPublica [has created a] never-before-available tool” they're calling an "Adjusted Complication Rate." Long story short, they've developed and launched a scale ranking “Nearly 17,000 doctors performing low-risk, common elective procedures such as gallbladder removal and hip replacements... in the new calculation...derived from government records collected about Medicare patients...” The score looks at post-operative complications “like infections, clots or sepsis” and a handful of risk factors such as “patients' ages, the quality of the hospital where the surgery took place, and other factors.”

The goal is straightforward: provide consumers a tool through which to compare the quality of potential surgeons before scheduling a procedure, and create a highly public venue through which to shame, scare, or (more euphemistically) motivate both doctors and the hospitals for which they work to step up their games, sharpen their skills, and identify and remove roadblocks to top-notch patient care. As a bonus, proponents suggest that these changes will significantly reduce the cost of readmissions related to surgical complications. Considering that such readmissions for Medicare patients cost “taxpayers $645 million” between 2009 and 2013, this is no small benefit.

ProPublica's intentions are clearly noble, and they should be applauded for doing something. After all, you never get anywhere if you don't at least try! That said, I can't help but cringe at what looks alarmingly like the early stages of a repeat of the Common Core disaster in the making. They're right to note that not all doctors or hospitals are created or perform equally. Certainly those doing well should be rewarded, and those at the bottom of the barrel strongly motivated to improve.

But the inconvenient truth is that people are bio-individual, both physically and in terms of their physical, social and familial support systems. For example, as an NTP I can tell you that most people are walking around with all kinds of undiagnosed and unrecognized health issues that are directly relevant to their ability to heal and their likelihood of readmission. My sister the nurse can testify to the kinds of disastrous individuals and relationships patients often rely on for their post-procedure care. These things are not, and cannot consistently or realistically be, accounted for on this index. As a result, just like teachers, doctors will be penalized for things outside their control without recourse to explain or defend themselves. Doctors battling to revamp struggling hospitals, or serving the lowest-income, most at-risk patients will suffer the most in this respect, punished for their faith, elbow grease, and big hearts.

Many doctors will respond by taking the only protective course available to them: refusing to see or work with any patients who don't present as excellent candidates for a quick, clean recovery. Dealing with a messy family situation? Obese? Smoker? Low-income? Cantankerous or absent-minded? Watch how fast you get turned down and punted over to the waiting list for one of the handful of (low ranked) doctors still willing to take you! As it stands, this well-intentioned ranking will most likely have the unintended (if predictable) effect of making losers out of neediest, least-ideal, and highest-risk among the us and those who stubbornly continue to serve them.

I can't help but be deeply saddened to see this kind of thing happening. We need real answers; real initiatives that get at the heart of the problem (like the increasing loss of non-profit hospitals), rather than relying on false metrics and sideways pressure.

What do you think? Am I over-reacting, or does this strike you as terribly counter-productive, too?

Three Fun Things to Start Your December

Can you believe it's December already? Thanksgiving has come and gone, seemingly every radio station is saturated with Christmas music (God help us), and the days are starting to show their long,
dark sides. Before we start the rapid slide into holiday madness, I thought I'd share three fun things I saw around the web recently to make you smile:

It's all good until someone bombs the pub....

An Irish comedian wrote an open letter to ISIS, and it's hysterical.

An Iraeli dad wrote a "why my daughter is tardy" note that's short, honest and endearing. (And that made me think of my Dad patiently trying to braid my terribly uncooperative hair when I was little.)

The case for making your own (highly descriptive and personalized) job title. (Similar point made here.) When I was at Panera, my unofficial title (bestowed on my by my favorite baker) was "Evil Overlord" - how awesome would it have been to have that on my nametag?! These days of course, I can put whatever I want on my business cards...I might have to get creative!

What is making you smile this week?