I recall the night the story broke when Tiger Woods had his late night collision. My wife immediately remarked that he was having marital problems. She was correct but we had no idea of the extent of his problems or how fall he would fall. The events which have unfolded since have served as a source of reflection and the lessons which can be learned from these events have implications which touch upon virtually all facets of human interaction, including health care.
How did Tiger get into such a deep hole? One word sums up the key factor which permitted this to happen…isolation. While Tiger as the golfer was a very public entity, Tiger in his off the course world was isolated from those who could or were willing to give him feedback on his activities. At any number of points in time, he would have benefitted from someone who, upon seeing what he was up to, would candidly and forcefully told him, “DON’T DO THAT!” Each of his individual indiscretions could be viewed as small failures and with appropriate and timely feedback, he could have executed course corrections which could have resulted in avoidance of his catastrophic crash and burn.
Whether we are talking about individual people or organizations, we need to accept something short of perfection in terms of performance. Personal and organizational egos need to be prepared for failure and the lack of any failures is indicative of one of two states, neither desirable. Perhaps the lack of any failures is indicative of an overly risk averse culture where nothing which cannot be guaranteed is attempted. Over time, this type organizational or personal culture virtually guarantees catastrophic failure because it suggests the inability to change and adapt to change.
The second scenario is associated with the lack of mechanisms to detect failures. I suspect that any number of people were privy to Tiger’s Woods ongoing indiscretions when they were ongoing. In an ideal world he would have interacted with a wide range of people, at least some of whom would have had the insight and motivation to provide him with the feedback that these activities represented undesirable activities, prompting a course correction and a different course of events. However, this did not happen. Tiger Woods was isolated from feedback and the fact he was isolated resulted in him ending up at a destination where he really did not want to be.
The broader lessons are obvious. This sequence of events is not isolated to Tiger Woods. Virtually every personal and organizational failure in recent (and probably distant) memory can be traced to personal or organizational isolation. Financial bubbles and corporate meltdowns can be traced to adoption of flawed financial models by small inbred leadership groups which operated within cultures which stifled dissent and frowned upon any sort of failure, even small ones.
Medicine is vulnerable to these same phenomena, particularly ambulatory practice. For a physician who is not hospital based, how does he (she) get feedback on a regular basis? Who can a physician who practices in this environment rely on to alert them to the small failures in order to make the small course corrections required to avoid the major crashes? We tend to allow our physician colleagues great latitude in terms of their behaviors, but are we respecting their autonomy or are we acting like Tiger Wood’s enablers?