The volume and complexity of what we know has exceeded our ability to deliver it’s benefits correctly, safely or reliably. Knowledge has both saved us and burdened us. – Atul Gawande
It’s unmanageable what we have to know these days, and it’s not our fault.
It’s simply impossible for us to remember everything we’re expected to – like the tens of thousands of medical conditions and unique combinations of presenting signs and symptoms and the hundreds of physical exam techniques and clinical practice guidelines that seem to change more often than not.
It’s no wonder we make avoidable mistakes.
When I was younger I knew all of the body systems and understood how many different kinds of medications worked, and I could remember the recommendations for hypertension and diabetes screening and treatment. I soaked up information like a sponge.
And then about 4 years ago I saw that things were changing. I was unable to keep up with the latest recommendations in primary health care. I couldn’t remember every physical assessment or every question I should be asking, and I stopped attending conferences and seminars I felt like I should attend.
Basically, I lost the interest and ability to learn what I needed know.
At the same time, I realized that I could easily look things up and if something was important enough to know, I could simply right it down or know where to find answers to my questions.
What’s the point in memorizing the signs and symptoms of diseases, common screening tests, or treatment recommendations when they are instantly available to us?
Few people go home after a 12 hour day to memorize what’s new in their field. Almost no body remembers what they hear at conferences. And hardly anyone has the ability to retain and apply information perfectly and consistently.
The reason is simple: information is infinite, but our mental capacity is not.
Take a look at the ads in your mailbox, the magazines on your desk, the presentations you go to, the textbooks on your shelf, the handouts you’re given, the conferences you attend, and the posters in the waiting room. Don’t forget the stupendous amount of information on the Internet.
There’s a lot of noise, and it’s only getting worse.
We’re in an information crisis, and the last thing we should be doing is expecting people to do risky work based on memory, and memory alone. It’s not how pilots fly planes, nor how engineers build sky scrapers.
So why do we expect health care professionals to memorize what ought to be written down?
As Atul Gawande says, in situations that involve risk, uncertainty and complexity, human beings cannot and should not be relied upon to avoid failure on their own. No amount of education or expertise can prevent human beings from making mistakes, even the most experienced among us.
Clearly, we need new strategies for managing the staggering amount of information in our work. Strategies that overcome the fallibility and inadequacies of the human brain. Strategies that don’t rely on memorization, because memorization simply doesn’t work.