msb-0165 The Costs of Being Wrong.

msb-0165 The cost of being wrong.

intro

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Main Topic: "The Cost of Being Wrong."

Part of being wrong, of failing, of screwing up, is that it costs.

(Post-implementation reviews will always reveal something to be learned, if some person is smart enough to do one, instead of taking success as an inevitable result, or of just walking away and washing one's hands of the entire mess.)

It always costs.

Not always in money, but it can cost plenty.

In medicine, the costs never seem to be borne by the ones who are doing wrong. (Except in those rare cases where you can prove gross negligence.)

Everybody's expected to just suck it up, shut up and limp on out; or to go into the ground. (Architects can only advise their clients to plant vines... Doctors can always bury their mistakes...)

With MS, and this is something that any and every MSer is intimately acquainted with, because of the nature of the disease, patients go through several rounds of testing, leading to mis-diagnosis, leading to more testing, leading to more mis-diagnosis, and round and round it goes until the symptoms reveal themselves unambiguously, usually during a bad episode (usually called a severe crisis.)

By that time, some damage is usually permanent.

Being damaged often costs a career, a marriage, a family, a shattered ego, a life irretrievably altered. Some of the costs are absolute bitches to pay and some are absolute killers, and not just of the budget.

All life is balanced on a razor's edge and we're sliding on down. (OUCH!)

---- "invisible beatnik" by: "chris hardy" http://www.soundclick.com/chrishardy

Main Topic, part deux:

Part of the costs of being wrong is the cost of clearing out and cleaning up whatever screw up, ding or scrape was the result of screwing up. (If it had worked properly in the first place, you wouldn't have to clean up a mess, now would you? [Problem is that the medical profession only rarely has to bear those costs.])

Then you can begin anew.

Part of the problem of beginning anew is that the "tabula rasa", the clean slate, is that the slate is not usually that cleanly wipe-able. There are "sequelae".

I am not a diagnostician. In my day job, as a software testing project manager, I very rarely have to run diagnostics on computer systems. I'm not looking for systematic problems, so I very rarely have to look at anomalous behavior and try to determine a source. (In fact I am specifically looking for the opposite: I am verifying that my systems are well behaved.)

I am not qualified to say where the problems lie when things aren't working, only that the behavior observed is the proper and expected one. (Well not explicitly qualified, but I can usually hazard a damn-good guess. :-)

Doctors are faced with some of the same problems.

For the most part, they just apply heuristics (rules of thumb,) and leave the stochastics (the guess work,) to the diagnosticians.

Doctors aren't given to the kinds of rigor of procedure while maintaining a flexibility of thought required of diagnosticians. (The best living diagnostician isn't. Its an AI program called Mycin. [But it requires updates with new diseases and new symptoms, and that those updates be done in a form that it can understand. {As such its a dead-end, except that it will usually score higher on accuracy than an average doctor.}])

And that's part of the costs of being wrong.

---- "Invisible Armies" by: "Amy Abdou" http://www.amyabdou.com/

Outro