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Wednesday, June 8, 2011

The Radio Fence Principle

My wife and I get out to walk around the neighborhood. Sometimes we take our dogs, sometime not. I remmeber as a child that walking around the neighborhood could be a dicey activity since many of the dog owners simply left their dogs to run. That simply does not happen any more where we live.

One tool which is used to confine dogs is the Radio fence. It is really an amazing device and I marvel at how well it works. I think there is are deeper principles which we can learn from the electric fence.

Why do these devices work so well? It is because they do two things extremely well. First, they provide warning when your pet is approaching a boundary which they should not cross and the warning gets more pronounced as the the pet gets closer to the boundary. Second, the consequences of crossing the boundary are consistent and substantial.  Pets guided by this technology get robust and consistent feedback

I am not one to suggest that people would be better off if our lives were so constrained and defined and every realm we operated in was bounded by such bright lines. However, I see the consequences of lack of feedback everywhere in the human world. We look at the latest scandal in Washington and I can only wonder how Representative Weiner could do such a stupid thing? The answer...lack of feedback. He had been doing this for a while with no particular consequences or warning that he was venturing out of the bounds of acceptable behavior.

Within every profession, there are individuals who push the envelope on acceptable activities. Rarely do they get early (or any) negative feedback from their peers. The mortgage business melted down because there was little useful feedback when an entire industry wandered down a financial dead end.  The King of Torts Richard F. "Dickie" Scruggs , former A6A naval bomber pilot, prominent trial lawyer, and the brother-in-law of former U.S. Senate Majority Leader Trent Lot pleaded guilty of bribery in 2008 and was sentenced him to 7 years. Dr. Mark Midei, a Baltimore Cardiologist purportedly implanted stents in hundreds of patients who did not need them. In each case described above, the perpetrators were not called out early for their behavior, they were in many cases idolized by their peers for their financial success. They were celebrated as being at the top of their games until they were indicted.  Within medicine, peer review is supposed to keep such impulses in check. Bob Wachter blogged on the inadequacies of the present system when Dr. Midei's case hit the press.  http://www.kevinmd.com/blog/2010/07/mark-midei-failure-peer-review.html


The lesson of the radio fence is clear. Any system which does not combine consistent feedback in the form of consistent warnings and consistent consequences will fail. Bad outcomes is often followed by the cry for more rules. However, more rules will not accomplish anything if they create more ambiguity in terms of lines which cannot be crossed and are not accompanied by tools allowing for consistent enforcement.

2 comments:

  1. Before you post any more one sided drivel about Dr. Midei perhaps you should do a bit of research. Possibly no one stepped in because nothing he was doing was any different than any other MDs at the time. Were you in the room while the stents were being implanted? If you are indeed the medical contrarian, do some homework and come up with an original idea.

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  2. You are correct. I was not there. I changed the wording to state that Dr. Medei purportedly implanted stents in those who did not need them, which is a more accurate reflection of the facts I know. Dr. Midei would still have benefited from the radio fence principle receiving some negative feedback before the hammer came down.

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