Doctoring Health Care Health Care Reform Knowledge Reflection

Medical decisions – the illusion of control

This is a very short story about a baby bird, a yoga mom and a hawk. I tell it because it made me think about the disordered way we frame healthcare decisions.


The neighborhood is one of old brick houses, cracked cement sidewalks and tall trees. What was once a suburb is now a city neighborhood. What was once a community of older folks is now one of young couples and children. There is money here. There is education here. This is not the 1% but maybe the 2.4%.

The fit young mother dressed in yoga pants and a bright-colored top was pushing a jogging stroller with two children. A typical image in the land of the educated and tall trees and brick houses.

It was a peaceful morning walk when the baby bird appeared next to the sidewalk with cracks. The mom stopped and swiveled the stroller so her offspring could bear witness to the cuteness. It was a zoo moment. It was tranquil.

Then it happened.

The hawk was big and brown and muscular. She came from nowhere. Her talons were sharp and effective. Though strong, the hawk struggled against gravity to elevate with the extra weight.

The delay was an opportunity.

It was the moment in which the woman with the stroller and colored top and yoga pants tried to intervene. Surely she, of the influential 2.4%, could change the course of the event—of nature. Here was a wrong that must be righted. The baby bird’s punctured lung and viscera could be un-done. The talons removed, the hawk reprimanded, the innocent baby restored to its former self. Nature controlled.

But of course it could not.

Another neighbor later told me that the human mother was worried that her children might be scarred. Scarred not just by the death of the cute baby bird but also the mother’s lack of influence over nature. She tried to stop the hawk, help the bird, but she had failed.


You see the (construct) problem?

What is it about human beings in 2014 that think we exert this much control over nature? Why the fantasy over expectations?

A mother is no more able to undo the behavior of a hawk than she is to make her surgery go perfectly, or a hospital staffer not to roughly roll an old man almost out of bed (my experience with my grandfather), or a cardiologist not to be influenced by effective marketing and fee-for-service incentives. Such are fantasy constructs, ones of deeply disordered expectations, of perfection and control.

But nature is not like this. Neither is healthcare.

Mistakes are not abnormal. Medical errors are indeed part of medical practice. Death is not abnormal. Death is damn normal.

And no matter how hard the healthcare system tries, with its protocols, work-hour restrictions of resident doctors, multiple layers of timeouts, armies of plaintiff lawyers, institutes of safety measures, and even public reporting of how well doctors check boxes, hawks will still kill, baby birds will still die, and no treatment will be free of risk or conferring of immortality.

We, patients and doctors, should collectively buck up and face our own hubris.

Control is an illusion. Perfection is fantasy. Errors are nature.

Imagine the improvement in medical decision-making if both patients and doctors stopped thinking we could save baby birds from hawks. Imagine if our construct was more modest.


5 replies on “Medical decisions – the illusion of control”

Like I said John – You have another career waiting for you in writing (= meaningful writing to convey a message). The same scenario you describe played itself out for me a little while back. A little bird was trapped in our screened-in porch and couldn’t get out despite the screen door being wide open. I was in process of trying to catch the bird so that I could usher it out – when somehow our playful big dog got out of our house onto the porch. It was over in a second before I could do anything. I experienced all the feelings you described in those few helpless seconds …. It was actually my years of teaching medicine to others that helped me to resolve those feelings. The sadness of what and how it happened did not go away quickly – but at least realistic acceptance did help … THANKS as always for your short story.

Nice article.
You write about acceptance.
I agree.

But today’s healthcare is more about control. The control should be held by the patient, physician and other healthcare professionals.

Unfortunately it is presently being held by third parties such as insurers, government, hospitals, etc.

The bird that had the bad outcome in your story had that outcome because of a bad decision of its own doing. We can not change that outcome after the decision has been made. Yet in today’s system we take much of the flak for bad outcomes.

Let’s return the system to one where patients control their decisions, and physicians control ours. We still won’t be able to make everyone happy or save every life, but we should be able to do a much better job.

The kind intentions of the mother also missed the teaching opportunity that the hawk was hunting either to feed its own babies or itself. Even vegetarians do not condemn the carnivores that help keep prey animal populations in balance for killing and eating other animals.

It is not wrong for that young bird to eat a worm or an insect, or one insect to eat another. It is not wrong for one bird to eat another. It is part of the cycle of life.

If instead the mother had said this hawk is feeding its own babies and that life has risks we must learn to avoid, the young children might well have accepted that just as easily as the children of hunter/gatherer societies have for all of human evolution. To tell children that it is ok to eat meat for health but remember that when you do, a living animal dies and wasting that death by throwing away half eaten food is disrespecting life. Such disrespect makes it easy to poison the planet and selfishly consume far too big a share of critical resources everyone needs.

It’s the warm fuzzy feel good memes that life is totally safe and nothing dies for us to eat that seem more likely to leave scars when the meme is discovered to be as much of a myth as the Easter bunny.

Nice analogy. I am studying for the boards and I wonder what good to sacrifice so much time with the purpose to help patients when some protocols, rules and regulations will establish what I do, how I do my job. Victor Hugo said speaking about flying “Love and science are the two wings that made mankind flying” in both domains love and science also to evolve we need to loose our barriers of control, it might sound utopic but is not impossible. Control it is such a delusion… Sayonara!

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