Over at Aeon, there’s a thoughtful essay written by the American anesthesiologist Ronald Dworkin about how he unexpectedly began suffering from anxiety after returning to work from a long vacation. During surgeries he became plagued with doubt, where he experienced difficulty making decisions during scenarios that had never been a problem for him before.
Dworkin doesn’t characterizes his anxiety as the addition of something new to his state of being. Instead, he interprets becoming anxious as having something taken away from him, as summed up by the title of his essay: When I lost my intuition. To Dworkin, anxiety is the absence of intuition, its opposite.
To compensate for his newfound challenges in decision-making, Dworkin adopts an evidence-based strategy, but the strategy doesn’t work. He struggles with a case that involves a woman who had chewed gum before her scheduled procedure. Gum chewing increases gastric juice in the stomach, which raises the risk of choking while under anesthetic. Should he delay the procedure? He looks to medical journals for guidance, but the anesthesiology studies he finds on the effect of chewing gum were conducted in different contexts from his situation, and their results conflict with each other. This decision cannot be outsourced to previous scientific research: studies can provide context, but he must make the judgment call.
Dworkin looks to psychology for insight into the nature of intuition, so he can make sense of what he has lost. He name checks the big ideas from both academic psychology and pop psychology about intuition, including Herb Simon’s bounded rationality, Daniel Kahneman’s System 1 and System 2, Roger Sperry’s concept of analytic left-brain, intuitive right-brain, and the Myers-Briggs personality test notion of intuitive vs analytical. My personal favorite, the psychologist Gary Klein, receives only a single sentence in the essay:
In The Power of Intuition (2003), the research psychologist Gary Klein says the intuitive method can be rationally communicated to others, and enhanced through conscious effort.
In addition, Klein’s naturalistic decision-making model is not even mentioned explicitly. Instead, it’s the neuroscientist Joel Pearson’s SMILE framework that Dworkin connects with the most. SMILE stands for self-awareness, mastery, impulse control, low probability, and environment. It’s through the lens of SMILE that Dworkin makes sense of how his anxiety has robbed him of his intuition: he lost awareness of his own emotional state (self-awareness), he overestimated the likelihood of complications during surgery (low probability), and his long vacation made the hospital feel like an unfamiliar place (environment). I hadn’t heard of Pearson before this essay, but I have to admit that his website gives off the sort of celebrity-academic vibe that arouses my skepticism.
While the essay focuses on the intuition-anxiety dichotomy, Dworkin touches briefly on another dichotomy, between intuition and science. Intuition is a threat to science, because science is about logic, observation, and measurement to find truth, and intuition is not. Dworkin mentions the incompatibility of science and intuition only in passing before turning back to the theme of the role of intuition is in the work of the professional. The implication here is that professionals face different sorts of problems than scientists do. But I suspect the practice of real science involves a lot more intuition than this stereotyped view of it. I could not help thinking of the “Feynman Problem Solving Algorithm”, so named because it is attributed to the American physicist Richard Feynman.
- Write down the problem
- Think real hard
- Write down the solution
Intuition certainly plays a role in step 2!
Eventually, Dworkin became comfortable again making the sort of high-consequence decisions under uncertainty that are required of a practicing anesthesiologist. As he saw it, his intuition returned. And, though he still experienced some level of doubt about his decisions, he came to realize that there was never a time when his medical decisions had been completely free of doubt: that was an illusion.
In the software operations world, we are often faced with these sorts of potentially high-consequence decisions under uncertainty, especially during incident response. Fortunately for us, the stakes are lower: lives are rarely on the line in the way that they are for doctors, especially when it comes to surgical procedures. But it’s no coincidence that How Complex Systems Fail was also written by an anesthesiologist. As Dr. Richard Cook reminds us in that short paper: all practitioner actions are gambles.
Surfing Complexity 