Judgments, Norms, and Other News

Gawande and Williams

Judgments, Norms, and Other News

Gawande and Williams

Judgments, Norms, and Other News
An email conversation about the news of the day.
March 17 1999 10:52 AM

Gawande and Williams

VIEW ALL ENTRIES

I wish I were that iron man, but, sadly, genuflection would be undeserved. First of all, the spouse of my previous e-mail who gets a bit stubborn and testy with illness is me. Secondly, my wife, Kathleen, who gave up life as a magazine editor to manage our little brood, gets the credit in the child-raising department--especially given the trials of three difficult pregnancies and my life in surgical training. And thirdly, I can't even claim that work life is all that taxing. At the moment, I'm on a hiatus from full-time cutting and sewing to get some research work done over here at the School of Public Health.

Advertisement

Now back to normative errors. It could be that I'm being a softy on President Clinton because I was a policy advisor for him in 1992 and 1993 (and for Al Gore before that). But I hope not. Rather, my reluctance stems from recognizing that a strict standard about lies and such can't be applied everywhere. In my mind, the key distinction is not whether a person caught lying does life-threatening work or not (and the president's work clearly does carry consequences of that magnitude). The key distinction is whether the lies are about the substance of that work or about what I'll loosely call "other stuff." The point of my adulterous-surgeon example is simply that lying about a sex affair would not be a dismissible offense in our world, but knowingly providing false patient information to team members certainly would be. I think we all implicitly and wisely recognize this distinction in our separate roles. And I think that's why the public is letting Clinton off the hook on the Lewinsky affair but wasn't about to let Nixon off with his cover-up of a break-in at the Watergate.

This horrendous crash in Bourbonnais, Illinois, in which an Amtrak train collided with a tractor-trailer crossing the tracks and left at least 13 dead and 100 injured, brings up another twist on these issues. Immediately we want to know who's to blame. The truck driver claims the crossing gates malfunctioned, coming down as he was going across. But the train engineer saw the truck try to go around the closed gates, and there are some suspicious tire marks consistent with that explanation. The most intriguing aspect to me is how sophisticated we've become about understanding these types of disasters. The Times points out that the gates at the crossing were a special new computerized type designed to come down about 25 to 30 seconds before a train gets there but not any sooner than that. When gates were made to come down sooner, it turned out that people assumed the gates were malfunctioning and then tried to jockey around them, leading to increased accidents. If the evidence shows that the trucker did try to go around the gates, we'd still want to know why. Was it because the gates were down too long and he figured they were broken (a judgment error, which seems relatively excusable), or was it because he didn't care less about the rules or the risks (a normative error, which merits punishment)?

All this decision and behavior talk has left me little room to talk about all the other interesting stuff in today's news. There's the Dow's briefly crossing the 10,000 mark (and all the accompanying articles that leave me confused about the market is wildly out of whack with the actual performance of the economy and individual businesses). I loved the story in the Times about Brooklynite Maurice Ashley, who's become the first black chess grandmaster. Medicare reform died yet again. And the Republicans put out a budget that provides a 10 percent tax cut and pays for it by cutting the budget for emergency aid, science, environmental programs, and other discretionary spending. Oh, and then there's Gore, who I guess is down in the polls. I'll have to pick up on some of this stuff later.

Atul

Atul Gawande has written about medicine for The New Yorker and Slate, is a surgical resident in Boston, and is a fellow at the Harvard School of Public Health. Marjorie Williams is a contributing editor at Vanity Fair.