Thursday, 18 July 2013

When reasoning and action don't match: Intentionality and safety

My team have been discussing the nature of “resilient” behavior, the basic idea being that people develop strategies for anticipating and avoiding possible errors, and creating conditions that enable them to recover seamlessly from disturbances. One of the examples that is used repeatedly is leaving one’s umbrella by the door as a reminder to take it when going out in case of rain. Of course, getting wet doesn’t seriously compromise safety for most people, but let’s let that pass: its unpleasant. This presupposes that people are able to recognize vulnerabilities and identify appropriate strategies to address them. Two recent incidents have made me rethink some of the presuppositions.

On Tuesday, I met up with a friend. She had left her wallet at work. It had been such a hot day that she had taken it out of her back pocket and put it somewhere safe (which was, of course, well hidden). She recognized that she was likely to forget it, and thought of ways to remind herself: leaving a note with her car keys, for instance. But she didn’t act on this intention. So she had done the learning and reflection, but it still didn’t work for her because she didn’t follow through with action.

My partner occasionally forgets to lock the retractable roof on our car. I have never made this mistake, but wasn’t sure why until I compared his behavior with mine. It turns out he is more relaxed than I am, and waits while the roof closes before taking the next step, which is often to close the windows, take the keys out of the lock and get out of the car. I, in contrast, am impatient. I can’t wait to lock the roof as it closes, so as the roof is coming over, my arm is going up ready to lock it. So I never forget (famous last words!): the action is automatised. The important point in relation to resilience is that I didn’t develop this behavior in order to keep the car safe or secure: I developed it because I assumed that the roof needed to be secured and I wanted it to happen as quickly as possible. So it is not intentional, in terms of safety, and yet it has the effect of making the system safer.

So what keeps the system safe(r) is not necessarily what people learn or reflect on, but what they act on. This is, of course, only one aspect of the problem; when major disturbances happen, it’s almost certainly more important to consider people’s competencies and knowledge (and how they acquired them). To (approximately) quote a London Underground controller: “We’re paid for what we know, not what we do”. Ultimately, it's what people do that matters in terms of safety; sometimes that can be clearly traced to what they know and sometime it can't.

Saturday, 13 July 2013

Parallel information universes

A few years ago, a raised white spot developed on my nose. It's not pretty, so I'm not going to post a picture of it. I didn't worry about it for a while; tried to do internet searching to work out what is was and whether I should do anything about it.

A search for "raised white spot on skin" suggested that "sebrrheic keratosis" was the most likely explanation. But I did an image search on that term and it was clearly wrong: wrong colour, wrong texture, wrong size...

"One should visit a doctor immediately when this signs arise": ignoring the grammatical problem in that advice, I booked an appointment with my doctor. She assured me that there is nothing to worry about -- that it is an "intradermal naevus", that there would be information about it on Well, actually, no: information on Becker naevus (occurs mostly in men, has a dark pigment); on Sebaceous naevus (bright pink, like birth marks), Blue naevus (clue is in the colour)... and many other conditions that are all much more spectacular in appearance than a raised white spot. I find pages of information including words ending in "oma": melanoma, medulloblastoma, meningioma, carcinoma, lymphoma, fibroma. If the condition is serious, there is information out there about it. But the inconsequential? Not a lot, apparently. Contrary to my earlier belief, knowing the technical terms doesn't always unlock the desired information.

Look further. I find information on a patient site. But it's for healthcare professionals:  "This is a form of melanocytic naevus [...] The melanocytes do not impart their pigmentation to the lesion because they are located deep within the dermis, rather than at the dermo-epidermal junction (as is the case for junctional naevi/compound naevi)." I feel stupid: I have a PhD, but it's not in medicine or dermatology, and I have little idea what this means.

I eventually work out that naevus or nevi is another term for mole. I try searching for "white mole" and find general forums (as well as pictures of small furry creatures who dig). The forums describe something that sounds about right. But lacks clinical information, on causes or treatment or likely developments without treatment.

At that point, I give up. Lay people and clinicians apparently live in parallel universes when it comes to health information. All the challenges of interdisciplinary working that plague research projects also plague other interactions – at least when it comes to understanding white moles that are not cancerous and don't eat worms for breakfast.