Assuming That: A Very Bad Plan

By

Leonard Zwelling

It is said that to “assume” anything makes an “ass” of “u” and “me.”

I agree with this.

I am reminded of this every time I go to a movie and something is wrong with the projection and the majority of the audience just sits there expecting something good to happen to restore the picture, sound, or both.

I always seem to be the guy (and there is always one other guy, too) who gets up and finds an usher to alert the manager that there is a problem in theater 12.

The same thing obviously must have occurred in Florida as the guard responsible for the safety of those in the high school stood outside expecting some other force to enter into the picture and help those being slaughtered inside. I guess he assumed that help would come. It did, but not in time to save seventeen souls.

Clearly, members of Congress assume that someone else will intervene to protect the high schools from another attack. Some of our so-called leaders want to arm the teachers, even though most teachers want no part of that. That was not what any of them signed up for, nor should they be expected to provide armed intervention with a concealed handgun should another young terrorist enter a school intent on wrecking havoc with an assault-style rifle.

I have seen this assumption in medicine all too often.

Patients are assumed to have a specific diagnosis without proof positive of the presence of the disease assumed to be creating signs or symptoms. This goes both ways. Really sick people are told all will be well and well people are often scared to death by caregivers who have not considered a true differential diagnosis.

I will never forget the patient with the “big liver” that my Duke attending wanted biopsied. I insisted on a scan first. The mass wasn’t his liver (his liver scan was normal) and a biopsy eventually showed it to be a cancer-laden kidney. Differential diagnosis, please.

Assuming that anything is true is a fool’s errand.

My favorite examples of assumptions are when people assume cause and effect when none has been demonstrated. Association is not proof of causality.

I love the example in Daniel Kahneman’s book Thinking, Fast and Slow. When training pilots in the Israel Air Force, the instructors thought they had found the secret of making better pilots. Yell at them when they did poorly and the next time they did better. But when they were complimented for a good performance, the next attempt went less well. Thus, yelling was the answer.

The real answer was explained by regression to the mean in that if you put enough pilots through enough training runs, some runs would be good and some bad. As Kahneman says, we want a deterministic universe, but the one we have is probabilistic.

Not assuming will also make the transition at MD Anderson from the totalitarian regime of the past few years to a shared governance world go well. Everyone must participate. Don’t assume that someone else will speak up. If you have a good idea, make it known. No assuming. All in!

Leonard Zwelling