We also fail because we don’t execute on what we know. Ignorance and ignorance about ignorance, however, are not the only reason we fail. To fix overconfidence, leading people through provocative, personalized examples may prove useful. Ignorance, thus, is not a sufficient condition for failure. If you know that you don’t know, you can learn. Ignorance, however, ought not to damn the practitioner to error. On creating specialties, Gawande has a great example: “there are pediatric anesthesiologists, cardiac anesthesiologists, obstetric anesthesiologists, neurosurgical anesthesiologists, …” Given that, you can reduce ignorance by (a) increasing the length of training, (b) improving the quality of training, (c) setting up continued education, (d) incentivizing knowledge acquisition, and (e) reducing the burden of how much to know by creating specializations, etc. Practitioners do not know because the education system has failed them, because they don’t care to learn, or because the production of new knowledge outpaces their capacity to learn. This leaves us with things that “we” know but the practitioner doesn’t. Of the things that we don’t know are things that no else knows either-they are beyond humanity’s reach for now. We fail because we don’t know or because we don’t execute on what we know (Gorovitz and MacIntyre). Gaurav Sood sends along the following contextualization of the checklist issue: My angle was that in statistics we are trained to think about interventions (and studying their causal effects), but intervention is not the only paradigm. In Colorado, the band found the local promoters had failed to read the weight requirements and the staging would have fallen through the arena floor.A few years ago, I was motivated to write about the intervention and the checklist: two paradigms for improvement, after reading Atul Gawande’s classic checklist manifesto. Guaranteed you’re going to arrive at a technical error.… Guaranteed you’d run into a problem.” These weren’t trifles, the radio story pointed out. “When I would walk backstage, if I saw a brown M&M in that bowl,” he wrote, “well, we’d line-check the entire production. The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment, and so many human beings to make it function.” So just as a little test, buried somewhere in the middle of the rider, would be article 126, the no-brown-M&M’s clause. And there were many, many technical errors-whether it was the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through. We’d pull up with nine eighteen-wheeler trucks, full of gear, where the standard was three trucks, max. As Roth explained in his memoir, Crazy from the Heat, “Van Halen was the first band to take huge productions into tertiary, third-level markets. This turned out to be, however, not another example of the insane demands of power-mad celebrities but an ingenious ruse. And at least once, Van Halen followed through, peremptorily canceling a show in Colorado when Roth found some brown M&M’s in his dressing room. “Listening to the radio, I heard the story behind rocker David Lee Roth’s notorious insistence that Van Halen’s contracts with concert promoters contain a clause specifying that a bowl of M&M’s has to be provided backstage, but with every single brown candy removed, upon pain of forfeiture of the show, with full compensation to the band.
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