Thread by @maelorin

Failure to communicate is endemic across our society. Silos (aka Bubbles) are undermining decades of progress. theguardian.com/commentisfree/…

Medicine is not the only profession struggling to get diagnosis right, and do it effectively. Changing how we teach skills is only part of the answer. We need to change the culture in practice.

Teaching skills and knowledge holistically only goes some of the way to addressing the compartmentalisation of professional practice.

The enduring problem is the culture in professional practice, in the communities in which people develop and excercise their skills and do their work.

We have underfunded, and overworked practically every occupation for decades. People have found ways to do their job more efficiently, but have largely been rewarded with having to do even more with even less: particularly less time.

Decision-making is a skill that takes time to develop, requires skill and knowledge to apply, and communication between people to do well. Mere data isn’t enough. Context is king in this game.

We need to stop the notion that ‘unbiased’ decisions are possible. We need instead to return to deliberation and collaboration as the foundation for good decision-making and good professional practice.

This requires a shift in culture, with a recognition that efficacy and efficiency are not the same thing. That people need to be informed to be able to make good decisions. That fear undermines this in fundamental ways. And that no decision can be ‘unbiased’.

There is a difference between prejudice and bias. We use them interchangeably without much discussion.

We have developed (and celebrate) a wider culture of ignorance and one-upmanship that promotes immediacy over deliberation.

That seeps into decision-making and practice in many hard-to-untangle ways.

I am not claiming that no one deliberates any more, or that every decision is a snap judgement without regard for consequences. I am saying that a general culture that promotes immediacy, in the context of organisational pressure to do more with less, has broad ramifications

I have watched several professions experience financial and managerial pressure to deliver more, faster, with less - less money, less time, less people. This has led to high turnover of staff as they get burnt-out - and get dumped into other systems that are also under-resourced

People who have spent 4, 6, 10 years training for their profession, only to be ground down within 2-3 years of starting work. This is an inefficient, ineffective, and horrendously abusive waste of people’s lives - their time, money, and futures.

Diagnosis is one of the hardest things to learn. You have to understand your discipline knowledge, you have to be able to obtain and interpret information from the world around you (including talking to and listening to other people), and to be able to make sense of it all

Diagnosis can take time. Collecting and understanding information is not a linear process in practice. You often learn new things after you have started to ‘solve’ the ‘problem’.

Most problems arise within systems. Systems are notoriously complex and complicated. This leads to the insight that teams of people, with a range of expertise and perspectives, are best equipped to investigate and diagnose: specialists and generalists working together.

I have seen this in healthcare, public policy, technology, legal services and lega practice, and in education. I have been the newbie, the expert, the manager, the specialist Generalist. I am a diagnostician in several disciplines/professions.

Diagnosis is generally not rewarded as well as ‘solving’ or ‘curing’ the problem. The end point is valued over identifying what needs to be resolved. Yet it’s integral to the solution. Solving the wrong problem creates further issues.

Diagnosis is recognised as an issue across every domain I’ve had contact with. Much time and effort is involved in teaching skills and knowledge to students to assist them in learning how to diagnose in their domain. Efforts are made to mentor in practice.

Then the ‘practical realities’ of practice - resourcing, timeliness, culture - intervene.

People are rushed and struggle to keep up with workloads. There is little time to communicate, deliberate.

And computers are not the solution.

You cannot replace people with a machine when the problem is people not having the time to talk, to think, to deliberate.

Machines cannot do the thinking and communicating for us.

They can do data. They don’t think. They don’t actually *learn*.

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