Fifty years ago at our medical school commencement ceremony our class was told that it was a “statistical certainty” that in the course of a medical career each of us would make a mistake that would cost someone his or her life.
The statistical background for this assertion deserves some scrutiny. A hypothetical medical student will serve as an example.
Suppose that to get into med school a student must have all A’s and that this is accomplished by getting 90% or better on every test taken as an undergraduate and also on the Medical College Admissions Test. Such medical students are probably fairly rare.
Let’s suppose that this means every medical decision made in medical practice will also be 90% likely to be correct. This is “A” work but means the first decision is 10% likely to be wrong.
Two decisions would leave a 19% chance of a mistake. This is 100% X [1 -(.9 x .9)]. After 10 decisions the probability of at least one error becomes 100% X [1-( .9 times itself 10 times)] or about 65%.
In the case of a really exceptional student with an A-plus average and a 99% chance of being right with every decision he or she makes, the chance of at least one error in 10 decisions improves to 100% X [1-(.99 times itself ten times)] or about 10%. Most cell phones can easily produce these calculations.
A hypothetical student of near Einstein-level brilliance might be 99.9% accurate with each decision he makes, and his chance of at least one mistake in 10 decisions is about 1%.
On the one hand, there are hundreds of thousands of decisions, not 10, made in a medical career, so mistakes will be made. On the other hand, most decisions are easy, routine, readily made ones, and life-or-death decisions come up infrequently. That said, there are even routine things that can go awry even for a doctor who is usually 100% right most of the time.
Missing a critical item in the medical history, omission of a critically important laboratory test, missing something on physical examination, giving someone a medication they are allergic to, choosing the wrong medication dose, or misreading a test result while in a hurry may lead to bad results in doing routine things.
No perfect decisions
Every decision is associated with a chance for error and, though it is small, mistakes will likely happen because of the enormous number of such decisions being made. The probability of never making an error is absurdly small.
A doctor, when confronted with a difficult decision, usually has the luxury of lots of time to think about it. He can mull it over, consult a specialist, re-examine the patient, get additional history, review relevant journal or textbook articles, order additional tests or phone a tertiary care center for an opinion from a super specialist.
Only rarely do medical decisions have to be made quickly, such as, for example, with a cardiac arrest or severe bleeding. As serious as these situations are, the correct response is largely cookbook, almost reflexive.
Other things to consider are that the doctor may be stressed because his office schedule has been disrupted by a hospital emergency, and he is hopelessly behind in seeing patients or that he may be distracted by other patient-related concerns. Perhaps he has been up all night with a critically ill patient and is barely able to keep his eyes open despite having to face a full schedule of patients in the office.
These are among the possibilities leading to errors in doing routine things. If the unthinkable should happen and a serious mistake is made, causing death or serious injury to a patient, a malpractice trial ensues and, unless there was gross negligence or a criminal intent to do harm, malpractice insurance will pay the plaintiff or his estate. A third or so of the settlement will go to the attorney, and that ends the matter, more or less.
The patient has suffered harm which might be permanent or perhaps has even died. The doctor is humiliated in court by the prosecuting attorney and in the media, whether found guilty or not, and, if an error has been made, will carry the burden of it the rest of his life. His practice will suffer and his malpractice insurance rates will likely go up. His employment might be in jeopardy. What he has done is only human. He has made a mistake. No one accuses the doctor of murder or insists that he be put in jail, but the legal system appropriately demands restitution on behalf of the patient who has been harmed.
Now let’s consider the situation of a police officer, also an “A” student, in a crisis situation, where he or an innocent citizen might be killed by a person wielding a lethal weapon like a knife or gun, or even a car, and the only means of prevention of a disaster may be the use of lethal force.
Like the medical crisis, these situations are fortunately rare. Unlike the medical crisis the response is not at all cookbook.
Split-second decisions
The best of police officers, even at the Einstein 99.9% accuracy level, have a significant probability of error in this situation. The officer is a human being and is not infallible. As with all of us, he can make mistakes and probability insists that he almost certainly will, at least on occasion.
He may have only a split second to make his decision, unlike the doctor, and he is certain to be highly stressed in this situation. His life may be on the line. Additionally, mental and physical fatigue may play into the scenario as well.
Crises like this most often develop in stressful, fatiguing circumstances. If the unthinkable happens and he makes the decision to use lethal force, there is no slack given him for the situation he faced, the stress he was under, or the usually extremely limited time he had to come to a decision. The media will sensationalize what has happened, paint him negatively with a broad brush, and often skew the reporting of the incident in a way that makes news rather than reports news.
There will be cries of “Murder!” rather than “Lawsuit!” especially if the parties to the incident were of different ethnicities. Today there will likely be violent protests and riots as well. This makes no sense. It seems to me that the policeman deserves better than this. If anything, the policeman deserves more slack, not less, than a doctor.
Why are policemen and doctors held to different standards? In a criminal trial, we often hear pleas for leniency because of the fatherless childhood home of the accused or his troubled background and limited education. Why don’t we regard a police officer who we expect to take great risks on our behalf with the same or an even higher level of compassion?
It seems that what is expected of a police officer is perfection and/or self-sacrifice. This is irrational. No human being can deliver on an expectation of perfection, and a human being’s first thought in a crisis is to protect himself and others, not self-sacrifice. For a policeman this is both a product of his training and an instinctual imperative to survive. We need to put ourselves in the officer’s place and ask how we would have done with the same split-second decision.
What has happened to common sense and the Golden Rule?
We also need to ask the person upon whom lethal force was used, how is it that they came to be where they were and doing what they were doing. What is their responsibility in this for putting themselves in jeopardy?
They are assumed to be innocent by the media, and this seems often not to be the case.
Sometimes the “victim” of an officer-involved shooting is a paid professional agitator trying to stir up mass chaos, while the person paying him may be hoping for just such an event to fan the flames even more. The policeman is assumed guilty and is tried in the court of public opinion while the very basis for that opinion is being cultivated by the media which is seemingly hostile to law enforcement.
Nobody’s asking the ‘why’
Nobody seems to be interested in the “why” of all this.
We need to rethink these situations and come up with something more equitable. Otherwise, we will not have policemen, and lawlessness will reign supreme.
Lawlessness is likely an underlying motive for some involved in encouraging the chaotic situations in which an officer-involved shooting often occurs.
It already seems to many would-be or present law enforcement officers that their service to the public is not worth the risk to themselves. Perhaps for some a climate of increasing lawlessness is the object of creating chaos in the first place. We already seem to be well on the way to being a lawless country.
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