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The Ubiquity of Gell-Mann Amnesia in Radiology, Health Care and Beyond
How often do we assume the trustworthiness of sources for content we are not knowledgeable on even if we have seen past examples of inaccuracy?
I was going to begin today’s blog with a pop quiz, challenging readers to remember a previous edition in which I shared the concept of Gell-Mann amnesia. That got derailed when my computer’s search function failed to find any mention of Gell-Mann in my “blogs” folder. There is irony in that. Either my machine is acting like it has amnesia, or I have experienced amnesia’s kissing cousin, confabulation, and never actually wrote such a piece in the first place.
Assuming the latter — that I have never written about it here before — I will explain it. Gell-Mann amnesia (let’s say GMA for short) was coined by Michael Crichton. He gave it that name because he had discussed it with Murray Gell-Mann and said that “by dropping a famous name, I imply greater importance to myself and to the effect than it would otherwise have.”
Here is a typical example of GMA: You find a news article on a subject you know well. (For Murray, that was physics. Crichton cited showbiz for himself, but he had also gone through med school.) Reading the article, you find it painfully obvious that the journalist has no understanding of his or her subject to the point where it is as bad as getting things 100 percent backward. Crichton called them “wet streets cause rain” news stories.
Annoyed or entertained by the horribly wrong article, you move on to the rest of the news, most of which is regarding subjects on which you are not an expert and proceed to swallow it all. It is no more likely to be accurate than the nonsense you just saw, but you are experiencing “amnesia” in that you have already forgotten the unreliability of your source(s). It is a sort of defense mechanism. We want to believe that there are more trustworthy sources of information than there really are.
In the fullness of time, I have come to see that GMA is far from isolated to the news or other venues in which we might struggle to remain informed. Color me cynical, but I think it pretty much extends to anywhere we assume, or at least hope, that the vast majority of people are competent and conscientious about their work.
Most of us in health care had our eyes opened to this as we became familiar with the field. Beforehand, like most of the population, we might have had illusions of brilliance, capability, and unblemished professionalism on the part of physicians and various other medical personnel. Moving from classrooms to hospital wards and clinics, sooner or later, the blooms came off our roses, and we discovered that folks working there had feet of clay just like everyone else.
One doesn’t need to work in this field to be so disillusioned of course. Anybody unfortunate enough to have in-depth experience as a patient, or a relative of one, gets the same harsh reminder of reality. That also goes for prolonged exposure to pretty much any other occupation, whether it involves legal representation, financial guidance, contracting, political office, etc.
Still, some of our preconceptions last longer than others. Doing clinical rotations in the latter half of med school, it was almost like I was checking off boxes. There were shades of the old Star Trek quip: “Beam me up, Scotty, there’s no intelligent life in this subspecialty either.”
To be fair, that is a tad harsh. Even if most of the folks I encountered in a given department were mediocre or worse, good eggs could be found doing what they could to hold things together. It has also occurred to me that working in a highly selective and competitive field probably cranks up one’s expectations of others who managed to gain entry. Even if you manage to create a population of nothing but hardworking geniuses, that population will have its own average level of performance. Fifty percent will fall below that, appearing less than by comparison.
Getting back to my clinical training, subspecialties I hadn’t personally seen, in my mind, were spared in my estimations through GMA until I did rotations in them or had sufficient exposure through consultations and the like. Surgery was one of the longest lasting holdouts since I didn’t see much as a student. It wasn’t until I was rubbing elbows with surgeons in residency and afterwards that I saw (surprise!) they weren’t any holier than everyone else.
One might think that, having fully immersed in a specialty like radiology, there is no GMA left to experience within it. The scales fall from our eyes, and we completely appreciate what we are dealing with. Don’t be so sure. There are always rads doing subspecialty work that you are not, especially if they are in some other facility with inner workings the are unknown to you. I might, for instance, have unrealistically high expectations of cancer care rads at Sloan-Kettering, or MSK rads at the Hospital for Special Surgery.
Sometimes, fortunately, one doesn’t have to blunder into personal contact with a situation to lose one’s GMA blind spot for it. For instance, I have written about a 1099 job I had a few years ago wherein the rad group had a ransomware attack and lost its ability to use offsite tele guys like me. It was only when I suddenly had zero income from them that I learned about “business interruption” insurance which, theoretically, would have kept me afloat.
Fast forward to the present day, and I am in another (far superior, thank heaven) 1099 gig. I reached out to get some insurance quotes so history couldn’t repeat itself. However, in the process, I started hearing from folks who said the biz-interruption coverage wasn’t such a godsend. For it to pay off, one evidently has to be disrupted for a lengthy while, and then there are various other hoops to jump through.
In other words, it is just like every other insurance I have encountered in my life. Companies make wonderful promises, give you impressive-looking policy documents and, of course, are very diligent about collecting your premiums!). However, when you finally have a claim, suddenly it is all paper pushing, bureaucracy, and technicalities. GMA had me believing that I simply must get this lifesaving coverage, but evidently one can “crowdsource” wisdom to escape the amnesia effect.
