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Decision Making Needs Critical Care

05/31/2020 10:35 AM | Anonymous

By Steven Reames

Over the past 2-3 months, we have witnessed in real-time the tough decisions that government officials, business leaders, and healthcare providers have had to make in the midst of the coronavirus pandemic. And in real-time we have heard, and maybe even voiced, some of the complaints that either not enough or too much is being done in response. This situation highlights the challenges faced by those in positions of responsibility: there will always be double-binds, you can only do your very best with the information you have at hand, and you will always have your armchair quarterback critics who have the luxury of instant replay and a bird’s eye view.

After hearing one of our member’s prediction in early March that, “It is going to be a poop-show here in no more than 1-2 weeks,” I stopped shaking hands and giving hugs when greeting close friends. Some of them dismissed my concerns saying, “No, that’s not going to happen here in Idaho.” But it was not long before physicians were pelting the Idaho governor’s office with calls to “shut the state down” hoping to slow the spread of COVID-19. They were reading the reports of rapid community transmission in Washington, California, and Italy and wanting to get Idaho ahead of the curve.

The Catch-22, of course, is that mothballing a HUGE chunk of our economy, delaying elective surgeries and preventive care, and physically and socially distancing ourselves from each other has its own yet-to-be-determined costs. While these decisions seemed to have slowed the spread of the virus in Idaho, we have yet to find out the short and long-term impacts on the physical, mental, and financial health of the greater population.

I am slowly learning to be less critical of decisions made under such conditions. I remember how, after the 9/11 attacks, Idaho Governor Dirk Kempthorne was criticized for closing Jefferson and State Streets alongside the state capitol building for a few months. There was veiled intelligence pointing to the potential of an attack on a building that looks strikingly like the US Capitol. Kempthorne worried that video footage of a terrorist attack on our local seat of government could easily be edited and retold on a foreign news outlet as a successful strike against Washington DC.

In retrospect, it seemed like an over-conservative move for our corner of the country that felt so far removed from the epicenter of what had happened in DC, Pennsylvania, and New York City. Nevertheless, when my friend complained about the governor’s decision, I said, “Haven’t you ever had to make decisions as a boss that nobody understood because they didn’t have all the information that you had, but couldn’t share, at the time?” She grudgingly conceded the point.

Similar types of judgement calls are made frequently by ICU doctors when the oath of “Do No Harm” is balanced with the reality of “but in order to do so, I have to place you into a temporary coma.” It will always be a risk-benefit analysis of which is worse: do little to nothing vs. overtreatment. I also know that many physicians beat themselves up for missing that “one clue” that they should have picked up in their differential diagnosis. Then they redouble their obsessiveness and perfectionism, vowing to never again make such mistakes, which sometimes leads to insomnia and the inability to “be present.”

When we look back and coolly analyze the year the novel coronavirus hit us, there will be glaring blunders, obvious miscalls, over- and under-reaches that can be seen with 2020 vision. We should remind ourselves now that this is the nature of making decisions in the fog of war vs. the clarity of an after-action review. This reality does not absolve anybody from being accountable for making poor judgment when good information was readily at hand. Similarly, pressure cooker decisions almost always expose what we really believe and assume to be true. But ultimately, we may need to destroy the myth that we can make a perfect series of decisions in the heat of any crisis, learning to extend grace towards ourselves and those who lead us.



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