In the beginner’s mind there are many possibilities, but in the expert’s mind there are few. —Shunryu Suzuki, Zen Mind, Beginner’s Mind
A man shot in the chest traveling in the back of an ambulance at 90 mph has one decision to make. Should he go to the local community hospital with extensive experience in gunshot wounds or the research institution 25 miles down the road with a nationally known specialist?
Most of us will choose the specialist. That could be a fatal mistake.
Even among highly logical thinkers like scientists, there is a universal tendency towards ‘authority bias.’ This is why the first thing an academic does upon reviewing an article is find out where the author got her Ph.D. The bias does more than choose reading material. It convinces us we are safer with a well known someone over a skilled anyone. The quick explanation is when we choose the nationally known surgeon, even if the outcome is fatal, it wasn’t their fault and it wasn’t your fault. Stuff happens, right?
But if a ‘nobody’ from a community hospital does the procedure and the patient dies, the headline is “surgery botched by community doc.” We would much rather risk our lives than make a decision friends will criticize.
There is ample reason now to choose the less credentialed alternative. The New England Journal of Medicine issued a report, Clinical Effect of Surgical Volume, that discovered when a surgeon completes his or her 60th procedure, they reach a proficiency level that predicts better outcomes. It exceeds other factors that include advanced degrees, reputation, and prestige. It summarized the findings as “ volume may be a surrogate for what we care about (good outcomes).”
Surgery is a complex art, not unlike managing a global enterprise or planning a wartime maneuver. We should rethink whether we have allowed credential worship to rule out the value of experience in these complicated endeavors. Or at the least, be sure that credentials and experience are aligned in decision making.
In surgery, the shift in emphasis to practice over prestige is happening on a wide scale and great hospitals are making a swift recovery from the bias.
They have no choice. Making the right decision in their business is a matter of life or death.