Cops, docs and decisions

The practices of policing and medicine, in my opinion, are powerfully analogous. Cops and docs make highly consequential decisions as the essence of their jobs.  We look to them to help us sort out situations we cannot control and that are in some combination scary, confusing and menacing.  In responding to these crises officers and physicians are asked to manage their own cognitive biases in order to arrive at the best possible diagnosis given the facts and evidence they find.  They must bring to bear their experience without being misled by it.  That is a hard path to find by yourself sometimes.  Recently in New York, an error by emergency department personnel contributed to the death of a 12 year-old boy.  It’s worthwhile to reflect on an observation that one doctor made in reference to the situation.

The observation is quoted in a story by columnist Jim Dwyer in the NY Times of July 18, 2012:  After Boy’s Death, Hospital Alters Discharging Procedures

Dwyer wrote:

“NYU Langone Medical Center announced on Wednesday significant changes in its procedures after the death by septic shock of a 12-year-old boy who was sent home from the center with fever and a rapid heart rate.  Rory Staunton died of septic shock on April 1 after being sent home from the hospital days earlier.

“Three hours after the boy, Rory Staunton, left the emergency room, a laboratory test showed that his blood had extraordinarily high levels of cells associated with bacterial infections. He subsequently went into shock and experienced organ failure, and died three days later, on April 1. His parents said they were not told about the lab results and were unaware of how seriously ill their son was, having been assured that he was suffering from a typical stomach bug.”

Some hospitals made defensive-sounding statements about how hard it can be to diagnose sepsis, the all-body infection that killed the boy.  Another doctor made a point about the tragedy that is worth reading:

“Others, though, were alarmed by what they saw as evidence of glaring clues that were overlooked, poor communication, or a lack of flexibility in adjusting Rory’s diagnosis.

“Joshua Needleman, a specialist in pediatric pulmonology at Weill Cornell Medical Center in New York, said the implications of the Staunton case went beyond ferreting out a specific disease and showed how important it was for doctors to keep open minds.

“’The big questions are about how to integrate new information that doesn’t fit with the perception you have formed,’ he wrote in an e-mail. ‘How to listen to the patient when they are telling you something that doesn’t fit with your internal narrative of the case. These are the hardest things to do in medicine and yet the most important.’ Dr. Needleman said he planned to use details of the Staunton case to teach those points to medical students and was grateful that the boy’s parents had disclosed the painful details.”

If one wishes to fall victim to cognitive bias an effective method is to fail to communicate with the relevant parties: other professionals with information and knowledge and the patients/victims.  Even in a busy emergency room or emergency situation it is critically important to slow the decision down as much as is feasible and communicate conclusions to relevant parties.  They can catch the blind spots in the decision-making that the individual doctor or police professional, cannot, by definition, see (because they are his or her blind spots).

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About stephenomeara

My name is Jim Jordan. I have had the privilege of working with the Boston Police Department and hundreds more departments over my nearly 30-year career in police administration and city government. I am now teaching and consulting independently at www.sergeantsleadership.org. I have learned the best of what I know from the thousands of smart, dedicated and ethical police personnel and scholars who have guided me along the way. My address is named for the great Reform commissioner of the Boston Police at the turn of the 20th century. Commissioner O'Meara died just a short while before the Strike in 1919. He was replaced by a vicious puppet (of Gov. Coolidge) named Edwin U. Curtis. Had O'Meara lived events may have turned out quite differently.
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