Failure to Learn

A few months ago my mother was admitted to hospital with pneumonia and while she was in hospital two incidents occurred which highlight how standard treatments can block learning.

In the first incident, over several days while intensive antibiotics were being administered, my mother became delirious and paranoid. I did a little bit of research on the Web and found that certain antibiotics can cause such reactions (in fact several classes of antibiotics can do so). Now, to me, the logical response to this should have been to change the antibiotic. Instead her doctors added an anti-psychotic drug and a sedative. In other words, they added two more drugs to deal with the effects of the first one.

In the second incident, she was having problems with maintaining blood oxygenation due to chronic heart failure. I did some further research on the Web (one of my degrees is in epidemiology, by the way) and found that the herbal supplement hawthorne has been proven to be beneficial - in fact I found a meta-analysis of 14 different research studies published in reputable medical journals that confirmed the benefit of hawthorne and the absence of side effects. I brought this to the attention of her doctor but he was unwilling for her to try this supplement. I presume this is because it is not a standard treatment in Australia (yet it is an accepted treatment in Germany).

In both of these cases, following a standard treatment regimen meant that there was no possibility of learning, in the first case failing to learn that a serious side effect of a drug could possibly be eliminated by switching the drug rather than adding additional drugs with potential side effects of their own. And in the second case, failing to learn that an accepted treatment in another Western country could conceivably be beneficial to patients in Australia.

The nett result of this is that patients in this country receive less than the optimal treatment. There is no telling how many deaths or complications occur annually as a result.

However, this isn't limited to medicine. About 18 months ago, I had an abscess in a tooth. My dentist said that I needed to have root canal to treat it, which ended up costing me around $800. Presumably this is the standard treatment. A year later the same tooth became infected again, but instead of going to the dentist, I took a course of antibiotics and the infection cleared up with the tooth remaining sound. Had I gone back to the dentist I imagine they would have said that it needed to be extracted.

But here's the thing: suppose that I had been prescribed a course of antibiotics the first time around instead of the root canal. And suppose the infection had cleared. Then this would have saved undermining the integrity of the tooth and possibly the second infection. Is it likely that dentists will ever learn this? My guess is no: firstly because an expensive treatment provides no incentive to try a much much less expensive treatment and secondly because if they only ever use the technique they were taught they have no opportunity to observe the effect of alternatives.

So what do these personal examples tell us about continuous improvement?

Firstly, that where there is an accepted way of doing things that 'works' or appears to work, it may be difficult to get someone to try something that could work better, especially where there is an incentive to continue with the current practice.

Secondly,  people (including experts) are more likely to deal with symptoms than go back to root causes in solving problems. As a result, they add a further layer of complication which may obscure what is really happening.

Thirdly, the ready availability of quality information on the Web is no guarantee that it will be used. Natural human inertia will serve to keep things going the way they have always gone.

Fourthly, expertise and specialisation may blind someone to better possibilities in dealing with problems. What is standard in a profession may block learning of better ways of doing things.

Finally, there can be cultural barriers to improving methods, techniques and treatments. (In Anglophone countries, for example, herbal and traditional medicine are not held in high esteem, so effectively doctors discount the benefits of Chinese and Ayurvedic medicine, despite thousands of years of proven benefits.)