Eratosthenes was a Greek scholar of the third century BC. He was a mathematician among other things. But what I find amazing about him was that he was able to calculate the cicurmference of the earth without leaving his home Egypt. It did not require computer based mathematical calculations nor the advanced technology that became available centuries later. These technologies largely confirmed his finding that was based on observations of the differences in sun's position in Alexandria and the town of syene further south. While we ourselves are unable to make such intelligent inferences from our daily observations of nature, we almost always use simple logic and rudimentary math to get through this complex world. But unfortunately such simple approaches don't seem to work for professionals especially medical professionals and that too with regard to assessing their own competence. They prefer to search for inferences that do not question their competence.
It was diwali of 2005 and I was not expecting a call from Eratosthenes. However that morning, I got a call from Dr. Jaggy (name changed) whom I had met some months ago in a conference in south India. He wanted to know more about one of the latest incubator models in the market. As we got deeper into the discussion, he told me that results from the IVF treatment cycles were not as good as expected and concluded that a better incubator would solve his problems. Sensing that there was an underlying issue that may have triggered the call, I was tempted to ask for details. This doctor like most others was in no mood to admit the need for help. And on the other hand I did not want to sound like I was looking for more work. I decided to remain in listening mode. This was not easy for me but I did not want to make it any more difficult for him. I decided not to ask for figures but I needed to decipher the numbers. There was no way I thought I could understand the problem without objective information. Erastosthenes came to mind and I decided to 'decompose' the problem. First I needed to know what the recent past meant. As my thought machine went to work, I expressed my wish that his diwali call should have brought better news than the 'lower than expected' results. The quick reply was indeed revealing as he opens up that he was hoping for the same since last Diwali. And at that moment, I felt like Eras who had just recorded the elevation of the sun in Alexandria. It was clear he had been struggling with this problem for more than a year. . A long standing problem that needed a solution also meant an opportunity for me. While I began calculating the money from a potential consulting opportunity presenting itself before me , I wanted to know what the embryologist on his team had to say about the problem. His reply was probably as illuminating as the sunshine over Syene. He said' "They all say that there is nothing wrong but the results don't improve." The word 'they' seemed to be louder and clearer than everything else. I couldn't control my curiousity any longer and I asked him ," what do you mean 'they'? I thought you had only one embryologist". His answer seemed to cover the entire circumference of the problem. I did not need to understand the science of deductive analysis to understand why changing members of his team did not solve his problem. In IVF the performance of a clinic is dependent on the competence of its doctors and embryologists and of course properly functioning equipment. A new clinic with new equipment that is deemed as functioning well by the continuously replaced embryologist is usually indicative of a problem with the third variable. But for a doctor who runs the show, it is easier to find an alibi in the incubator. This is a common problem with under performers especially professionals. Acknowledging their inability to perform a task within reasonable limits of acceptability is not easy. But when it comes to patient care, it is the obligation of hospital leadership to take remedial action when unnecessary suffering is observed.
A few days after that call that would bring me money, I was at the receiving end of under-performance. My wife underwent a caesarian in a hospital that had differentiated itself in the region for its higher standards of care. Prior to the caesarian, we expressed our preference for spinal anesthesia. But we did have question about the risks for which we were given very comforting answers. Unfortunately, my wife ended up in bed for several days suffering from severe spinal headache. For a complication that was usually rare, we were resigned to the fact that theory of probability did not work in our favor. However in the weeks that followed, I made some inquiries internally during my regular visit to the hospital as a consultant. I learnt that the spinal headache complication levels were alarmingly high and a couple of months later complaints from obstetricians led to the management instructing the anesthetists to reduce the use of this technique during caesarians. I found it quite strange that in a hospital doing about hundred caesarians a month, they could not zero down on the poor performer using simple math. I had to assume that an acknowledgement of incompetence and knowledge of basic mathematics is after all a rare combination in clinical care. Unfortunately patients are at the receiving end of this avoidable mix of poor self perception and selective ignorance.
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