Saturday, February 28, 2015

Resistance to Averageness

Before reading the article, I actually believe that technology is the determinant of healthcare quality. Healthcare is something that we have no ability to improve dramatically unless we have access to higher level of technology or  medicines. But the truth turns out to be the opposite. And I started wondering, for patients with Cystic Fibrosis, what exactly makes the difference between 80 percent of normal breath level and 100 percent, or even better.

I guess the key is the resistance to averageness. In the last paragraph the author writes, "When the stakes are our lives and the lives of our children, we expect averageness to be resisted. And so I push to make myself the best." When everyone is satisfied with 80 per cent of normal level for patients, Don Berwick pushed the patients in an "aggressive" way in order to keep their lungs as open as possible. That's why he cares about the difference between 99.95 percent and 99.5 percent at the circumstances with or without one-day treatment, which would lead to a huge difference in a long term. 

It reminds me of something called "illusory superiority", which represents a common cognitive fallacy people have -- I am above average people. For example, in the survey made by College Board, they asked students who take SAT to rate their own performance, 70% of students rate themselves above median. This applies to every aspect of skills or performance such as health, driving skills, memory or IQ. The fallacy that people are above average makes people feel good when they actually perform average, or maybe they're really better than average. However, few people would look up to see how much higher they could reach rather than comparing themselves to the "majority" to get the satisfaction and feeling of superiority. This is what Berwick is doing and what makes him unique.

So it raises the question that we might ask ourselves. Perfection is not easy to get. And sometimes we don't know about our limitations. As we've discussed before, it would be better if we could set a reachable goal to an extent that we can possibly reach by doing some efforts, instead of setting a ridiculously high one to discourage ourselves. But sometimes it needs the enthusiasm to pursue perfection in order to accomplish something others have never thought of. How could we find out our limitations? How could we define perfection? How could we avoid being prey to illusory superiority?


  1. I don't know why some words are huge... I've tried several times to reset the font but it didn't work.

  2. I'm only commenting about the formatting here. I will comment about the substance later.

    It looks like you copied from the original article and pasted into the editor. Unfortunately, when you do that, you sometimes inherit the formatting along with the text. To avoid that happening in the future, after you've copied, switch the editor to html mode and paste in that way. Then none of the formatting from the source will come through. You may need to reformat what you pasted in so it looks okay, but that way you preserve the integrity of the rest of your document.

    1. I actually wrote directly in the blog... I'm not sure how can I reformat it. Maybe I could try to type those sentences again to see if they're ok.

  3. I did sent the link to the piece The Bell Curve to you and Yuchen, but not David, since he didn't come the last time. As he might want to read the piece, I'm including the link here. Note that Nicole is making reference to that piece in her post.

    I was struck in what you wrote that you focused on performance level, but spent no time at all on what it takes to get to superior performance. I believe the following, taken from the piece, is the relevant passage regarding what is needed.

    "We are used to thinking that a doctor’s ability depends mainly on science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously."

    If you take that as a starting point, you might ask why aggressiveness, consistency, and ingenuity are rare. (If they were common, then everybody practicing them would be average, wouldn't they? I will offer up one possible explanation for this and try to tie it to the economics of risk and uncertainty we studied last semester.

    Being ingenious introduces additional uncertainty. It may raised the perceived mean outcome, but it makes things less predictable. You don't know if they will work are not. Perhaps over time you do better, by a law of large numbers argument. But in the near term you might do worse. Then risk aversion might prevent you from trying.

    If that makes sense, we should spend some time talking about whether people care too much about failing in a single instance and not enough about succeeding over the long haul.

    1. This comment has been removed by the author.

    2. Your point takes me to look at this problem in another perspective. I realized that many people have high motivation of pursuing a better result in a single instance. Sometimes I evaluate my own performance just by looking at the result such as grades. Being ingenious is risky because you don't have previous experience to learn from. Minneapolis's example might be just a rare case that taking risk leading to a better performance. But to be honest, I don't really understand why there is a conflict between caring about one instance's outcome and caring about long term result. For me, it seems that they are interrelated. In order to get a desirable outcome in one instance, people might unconsciously develop skills or get prepared for the long term task. I'm looking forward to talk more about this tomorrow!