Iatrogenics: When Systems Thinking Fails Us

A whole galaxy of multi-colored uppers, downers...One of my friends told me a story to explain the personality differences between himself and his wife, as they were opposite personality types. She once asked him how to send a particular email and he responded by saying, “Here are the things when you want to consider when sending an email: first….”. She interrupted and said, “I don’t want to understand all the principles of how to send an email, just tell me exactly what I need to do.”

He liked principles, the why, and she wanted rules, the what. Many people fall into these two categories of decision making. Most of us work with a mix of each depending on the situation and how much we know.  We tend to be more principle-based as we move up the Dreyfus Model of Learning and more rule based when none of it makes sense. Different situations require different criteria and both can be useful.

However, as we have developed more and more knowledge of the world around us, it has encouraged us to believe that we should always make decisions based on why. We believe we can understand a system sufficiently to completely understand the ramifications of our decision. We understand why we wash our hands, for example, because we understand germs.  At one point in time, they didn’t understand germs and would go from dissecting cadavers to delivering babies with fatal results. Improving our understanding of a system can help us make better decisions, but sometimes we don’t have enough knowledge of the system AND don’t realize it leading to disastrous mistakes.

Communism assumed that we could plan out everything leading to greater prosperity for all. Back in the 1930’s, Crisco argued that margarine is better for us because it’s made from vegetables unlike that harsh animal fat which causes poor digestion. The government assumed people would not invest in complex derivatives they didn’t understand – oops.

This overall belief that we can master these complex systems can lead to iatrogenic intervention. Iatrogenics is harm at the hand of the healer. The doctor believes he is intervening to help us, but in the process he is harming us in a way his systemic knowledge doesn’t comprehend.  Think of people who keep getting more drugs to cover up the side-effects of the earlier ones. We can make poor decisions even though we think we’ve thought it all out.

Understanding a system will help us work within it and make better decisions overall, but always recognize that in any complex system there are things we don’t know and even more things we don’t know that we don’t know.  Many times in those situations, the rules handed down through generations have wisdom even though we don’t understand why.

Picture Credit: ep_jhu






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