Is being an academic a disabilty (part 2)

The fancy term for knowing your own limits is "meta-cognition" -- that is, what you know ABOUT what you know.


According to Dror:

When it comes to experts, the following errors are common:

• over self-confidence
• do not listen
• discourage, frown, and 'punish' disagreement
• take undue risk
• Escalate commitment when challenged
• Wishful thinking
• Confirmation bias  (search for and see supporting facts but not conflicting facts.)

Again,  these are all errors that all humans tend to make, but non-experts may be much more aware of their own tendency to make such errors,  and recover from them gracefully the next day.

Experts, on the other hand, have a much higher level of investment in their reputation,  and there is no natural internal limit to the justified self-confidence they have in one area that lets them know they have crossed outside the boundaries of what they know and what they only think they know.

Among nurses,  there are often comments about specific doctors who consider themselves only a short step below God,  whose egos are so large that "they come into the room before the person."

But that's anecdotal and just jealousy right?  Wrong. Let's find some objective data. I'm a private pilot and follow this sort of thing.


Example:    Doctors have the highest rate of small aircraft accidents after any other group or profession, except teenagers.

Crash Risk in General Aviation,   by Guohua Li, MD, Dr.PH and Susan Parker, MPH,
JAMA. Apn1 11,2007-Vol297, No. 14 p 5196-1598.  (http://doctorgrayson.com/Aircraft.pdf )
which also cites
Booze CF Jr. Epidemiologic investigation of occupation, age, and exposure in
aviation accidents. Aviat Space Environ Med. 1977;48:1081-1091.

I can't right off find the statistics for teenagers, but I do recall noting it as I read it a while ago.

Note -- I can't find such data adjusted for the fraction of flight-hours which are by doctors, to get the accident rate per hour flown by occupation.     It's possible that doctors, being wealthier than average, tend to own their own planes and fly more than the general public, which would bias those rates upwards.  On the other hand, it's doubtful that teenagers own their own planes at all, or that they fly very much,   and MD's are not known for having a great deal of free time for leisure activities.   So it's also possible that MD's actually both own their own planes but fly only infrequently, so the accident rate per hour flown is even higher for MD's than the statistics would imply.

A more likely explanation, in my mind,  is that MD's are significantly more unaware of the limits of their own expertise,  and therefore take more risks than other general aviation pilots.

While others may find the behavior described by "ego" or "arrogance", the point is that the doctors are, in fact,   somewhat crippled by the unintended and invisible-to-them side-effects of their own expertise.

We can talk more later about the behaviors which result from an effort to maintain their own self-image in the face of conflicting data.   What is expected, given narcissism in general, is that all errors and unexpected outcomes are automatically blamed on others, or events outside control,  anything except blaming them on oneself.    The emotions related to questioning ones own identity become so high that fits of rage are reported by surgeons, say, when anything goes wrong, including hurling instruments across the room and screaming at others present, etc.

This, in turn has two social side effects.

• It reduces the probability that the MD will learn anything from the mistake.
• It reduces the probability that anyone who associates with the MD will point out their mistakes in the future.

Thus begins a feed-back process which increasingly isolates the expert from realistic negative lessons from outside.

The result, getting back to the start of this post,  is that an expert with a huge investment in reputation, face, and accuracy becomes increasingly isolated from social interaction and particularly isolated from ability to allow personal errors and shortcomings to be visible in public.

It's certainly well known in the hospital I.T. department, for example, that it is extremely hard to get many doctors to learn new software if it requires that they have to go through the required awkward and fumbling state in public,  let alone in the presence of their peers.

In other words, my original comparison group, the "giggling gaggle of girls", has much more freedom to explore, make mistakes, ask questions of each other,  and figure out collectively and even enjoyable how new things works, and can acquire new skills together in a totally non-competitive way, helping each other learn.

Experts, on the other hand,  may suffer severe disabilities in their social ability to operate in such a learning group.   They have, effectively, a trained incapacity in this regard.

And, because they lack awareness of the limits of their knowledge, this incapacity extends far beyond the areas they would be expected to be experts within,  to all other kinds of interactions in life.

To some extent, all people and most higher animals are quite aware of "face" and try to no do things that would embarrass them in front of their peers.   I've certainly observed that among bird flocks, cats, and dogs, as well as humans.

Also, to a very large extent, what people are inwardly terrified of is being thrown out of "the flock",  of becoming unwanted, undesired, an "outsider", or one of the "them" category that disparaging describes those outside the in-crowd.

The result is that the LAST thing in the world people want is some sort of effort to surface, reveal, tell-all, and show errors and flaws.      This, of course, makes something like the Toyota "lean" process, or Six-Sigma,   which is precisely designed to surface such problems,   astoundingly difficult, if not impossible to implement for corporate change agents interested in rooting out and fixing these deeper, hidden problems.

So, again,  those experts who have fallen into this trap, perhaps through no fault of their own, get a triple dose of the deeper anxiety everyone feels about being "found out" to be "a fraud" or "less than one has pretending to be."

The result is to build higher and higher protective walls and shells around oneself, and to avoid, at all costs, situations in which one might accidentally slip and reveal some internal flaw.

These days, in the corporate world and in politics,  often it only takes a single mistake, a single comment uttered in an unguarded moment,  caught by an open microphone,  to end an entire career and flag someone as expelled from the "in group."

The result has to be an intense loneliness and constant state of both rage at the stupidity and errors of those around one, and fear that one's own flaws will become visible.

Again, it is not surprising that the drug-abuse and suicide rate among MD's is quite high.  They have become emotionally and socially crippled by external forces and training, and are in every sense of the word disabled, unable to participate in the normal social activities of daily living that many people take for granted.

It is not surprising in this context that the development of Hospital internal Electronic Medical Record systems is running a few decades behind other industries.    The talk is concern about patient privacy, but the actual far deeper concern is that, by capturing everything electronically, it will become far easier for mere mortals,  even administrators,  to mine the data and detect and reveal weaknesses and flaws.

Moreover, in the corporate world these days,   administrators and managers are often those who have mastered the art of taking credit for anything good that happens, and deflecting blame for anything bad that happens, while keeping the spotlight focused anywhere but on their own performance.  (I'm speaking as an MBA who taught MBA's here,  and has been "in the kitchen.")

So,  the largest threat to such administrators is the brightest MD's, who can see through puffery and see what is actually going on.   Given the politics then, it is precisely such MD's who present the greatest threat to the continued position of the administrators, and it precisely such MD's that said administrators constantly seek any bullets, or flaws, or errors to use to "take them down."

So MD's have the curse of training that emphasizes inhuman perfection,   the dangers of expertise in general,  attorneys ready to pounce on anything that even looks like a bad outcome regardless how correctly it was managed,  and a sociopolitical environment that is constantly threatening to expose and demolish their careers and lives.

One last curse of MD's, CEO's of large companies, and military officers is that they have to make rapid decisions based on insufficient information, with huge or fatal consequences if they guess wrong.    On the other hand, they have to make a STREAM of such decisions, one after the other, in an environment where "paralysis of analysis" is also a sin of omission that may have worse consequences than a "bad decision" that at least can be detected and reversed shortly.

Humans have finite capacity to worry about things, so these experts must take situations that are full of conflict and doubt and FORCE them into a state marked "decided, do not reopen or worry about this any more,  or you'll ruin all subsequent decisions."

They are forced to master the art of putting uncertain decisions out of sight, out of mind, and not constantly worrying about them and revisiting them, or they'll simply be overwhelmed and quite literally go crazy.

But this also means they have yet another source of blindness and resistance to the arrival of new, contradictory data, which calls their prior decision into question.




Enough on MD's for the moment.

In my next post I'll look at the problems of expertise in the Executive wing, among managers and CEOs.   Again,  we'll see that those people who the outside world thinks have the most power and privileges in the world are among the most limited and the most crippled in their capacity to function as a healthy human being and member of society.



(more in part 3)

Is being an academic a disability? (part 1)

I began to wonder about the total impact of higher education when I had trouble setting up a video conference with some senior faculty in a prestigious university,  and discovered they didn't actually know how to do that.

I believe it is true, based on my observations, that a "gaggle of giggling girls",  pre-teens,  has a greater ability to master the intricacies of technical equipment, in particular a "cell phone",  than does the average senior faculty member at a university.     If you don't like the "cell phone" example,  use the mastery of completely free Voice-over-IP services such as Skype for long-distance calls, or calls around the planet for under 5 cents a minute.

I pick on females not because I am trying to be stereotypical, but because I am directly challenging several stereotypes at once, regarding females,  faculty,  and technical mastery skills.

I am not addressing activities that are of no interest to senior faculty members,  such as sharing their day to day lives on Facebook.   I am talking about simple communication, a basis for collaboration, as well as ability to master new technology given several years to find time to do so.

I believe this is a profound data point.   It calls into question many of our core assumptions, including the focus and evaluation of how we educate or youth.

In particular,  this instance highlights part of what appears on investigation to be a much larger problem -- the downside of academic education, and the downside of expertise.

In any rational measure of mastery of a cell phone as an "Activity of Daily Life" in today's society,  it appears that senior academics have to rate in the "disabled" category.

If it were only academics,  this would be important but, well,  "academic".   Sadly, the downside of expertise appears to apply as well, perhaps even more so,  to two very important groups -- business management,    and medical doctors.

And, of course, then if you are considering automating the electronic health record at a large academic medical institution,  you have all three to deal with, perhaps in the same group of people.

While it can be somewhat fun to disparage experts,  managers, and academics,  let's try to stick to known facts here, and see where our mental models need updating, and then look at what the policy implications are of all this.
------

First,  there are well-documented problems with experts and expertise.   A great deal of research has been done by the military,  and lately by those following financial disasters,  on how it is that some truly smart people can behave so stupidly, or  how a fully-trained, highly-motivated observer can miss exactly what it was that was right in front of them.

One well-respected researcher in this field is Dr. Itiel Dror, at University College London. Here's the abstract of a paper he published last year:


Dror, I (2011) The Paradox of Human Expertise: Why Experts Can Get It Wrong. In: Kapur, N and Pascual-Leone, A and Ramachandran, VS, (eds.) The Paradoxical Brain. Cambridge University Press: Cambridge, UK. (In press).

Abstract
Expertise is correctly, but one-sidedly, associated with special abilities and enhanced performance. The other side of expertise, however, is surreptitiously hidden. Along with expertise, performance may also be degraded, culminating in a lack of flexibility and error. Expertise is demystified by explaining the brain functions and cognitive architecture involved in being an expert. These information processing mechanisms, the very making of expertise, entail computational trade-offs that sometimes result in paradoxical functional degradation. For example, being an expert entails using schemas, selective attention, chunking information, automaticity, and more reliance on top-down information, all of which allow experts to perform quickly and efficiently; however, these very mechanisms restrict flexibility and control, may cause the experts to miss and ignore important information, introduce tunnel vision and bias, and can cause other effects that degrade performance. Such phenomena are apparent in a wide range of expert domains, from medical professionals and forensic examiners, to military fighter pilots and financial traders.


http://discovery.ucl.ac.uk/48372/





How can this be?

To illustrate, Dr. Dror suggests that you attempt the following task.
There is no rush and no time limit.   Don't proceed until you have
completed this task and feel confident you have not made a mistake.


Count how many 'F's are in the following text:

          FINISHED FILES ARE THE RE
          SULT OF YEARS OF SCIENTI
          FIC STUDY COMBINED WITH
          THE EXPERIENCE OF YEARS…

=========== stop here until you are done =======

V


V

V

V

V

V  ... take your time

V

V

V

V

V

V  ... double check your work

V

V

V

V

V

V

V

V

V

V

V

V

V

V

V

V

V

======== ANSWER BELOW.

The correct answer is six.  There are six F's in the text.  

FINISHED FILES ARE THE RE
SULT OF YEARS OF SCIENTI
FIC STUDY COMBINED WITH
THE EXPERIENCE OF YEARS…

Don't feel bad if you got it wrong.   I counted three.

 This is an example of a kind of problem that expert readers have that beginning readers, such as your young children, probably do not have.

Most people have learned to read for "content" and they have learned, implicitly, that the word "of" does not have much content, so their mind basically uses "white-out" on the words "of" and they disappear from our view.

The problem is that EXACTLY the same type of inability to see what is, in retrospect, in plain sight, happens to all kinds of experts -- including doctors,  CEO's,   and academics.

In fact, the more they have trained their senses to notice certain things, the LESS likely they are to notice other things that they have, at the same time,  learned to ignore.

So, can you see what's in front of you?

Identify the person in the image,  then turn around, back up 3 or 4 paces, turn around and see what you see.   From normal viewing distance, this is clearly Albert Einstein.  From across the room, this is "clearly" Marilyn Monroe.

There is a larger version at MIT where this "hybrid image" originated.
http://cvcl.mit.edu/hybrid_gallery/monroe_einstein.html

My point here is not just for fun --- people who are "close to" this data see one things, and people who are not "close to" this data see something else entirely.

We are surrounded by issues that are invisible in plain sight,  and sources of disagreement that are due to our perspective that we don't expect to be there.  Being an "expert" doesn't free a person of having the same types of problems, but it does decrease, substantially, their willingness to consider that an interpretation different from their own, especially by a non-expert, might have any value at all.

Back to the core point of this post -- Almost everyone has problems with their eyeballs, which are recognized and dealt with by "glasses" or "contact lenses" and not really considered disabilities. Some people don't like to admit they have a problem, and prefer to wear contacts, or avoid wearing glasses whenever possible.

However many people, and in particular experts, have a different type of problem with seeing that is an unavoidable side-effect of their expertise.   This is more subtle, and potentially much more dangerous, but also flies in the face of their own self-image of "expert" and therefore is not admitted, adjusted or compensated for.

The first step in dealing with a disability is recognizing that one has it, and also realizing that the world has not ended just because of an issue with one small sub-system of what it means to be human.

(end of part 1)