Saturday, March 24, 2012

Multiple lessons from Holland

As I prepare to be part of TEDx in Maastricht on April 2, with some follow-on sessions at Radboud University Nijmegen Medical Centre, I am reminded of the important World War II battle that took place at nearby Arnhem, depicted in the movie A Bridge Too Far.  The movie documents a number of organizational problems among the Allied forces that could have led to disaster.  The military leaders engage in the worse form of groupthink and, like doctors who are trapped by diagnostic anchoring, chose to believe only the evidence that supports their conclusions, notwithstanding evidence to the contrary.  They also suffer from the kind of hierarchical communications failure that we often see in hospitals, the sort that Crew Resource Management has been shown to forestall.

The Germans, expecting the invasion to be led by tank-master general Patton, decide to "rest" their major tank battalion in Arnhem.  The British and Americans are convinced that the German force is very weak in that location -- just "Hitler youth or old men" -- notwithstanding reports from the Dutch Underground that the area is heavily reinforced and commanded by a senior German general.  The Allies plan on dropping paratroopers eight miles (!) from the bridge in Arnhem, which they will get to and then hold until reinforcements arrive.

A young English intelligence officer, Major Fuller, is worried and gets permission to send in a low-altitude survey flight, which takes pictures of the tanks. In this segment of the movie (starting at 6:31), his commanding officer, General Browning, refuses to believe the evidence, notwithstanding visual proof supporting the Underground's reports.  Among other things, he doesn't want to be the one to tell Field Marshall Montgomery that the attack should be called off.

In an earlier segment, too, British officers conclude that the portable radios given to the paratroopers are not likely to work for the long distance from the drop zone to the Arnhem bridge amid the water and trees of the Netherlands. The officers choose not to rock the boat and do not convey their concerns up the chain of command.

Luckily this all turned out all right, if you ignore the wasted human lives that resulted from all these miscalculations and miscommunications. In war, it seems, as in hospitals, the reaction is often "these things happen."  But as documented in this movie, they don't have to.

If you cannot see the video, click here.


e-Patient Dave said...

I never would have made this connection, but yes: the general argues that if this were real, there would be more evidence. And in medicine (at least in the US), skeptics of the need for change assert that if it were real we'd have seen more evidence for it.

Have they become sheep, with no initiative in their own trained minds, assuming that if anything important were happening somebody ELSE would be telling them?

I get the thing about not rocking the boat, but this is a whole different issue.

Anonymous said...

Dave, for medicine, including the providers, the administrators, the insurers and the vendors - this is not about not rocking the boat; it's about not wanting anyone else to rock THEIR boat. That's the full dimension of what we're up against.


Martin said...

The battle depicted in "A Bridge Too Far" did not "turn out all right" - it was a debacle for the Allies.

Paul Levy said...

Ah, probably true, although Montgomery apparently termed it 90% successful.

Unknown said...

Actually, operation market garden is thought to be one of the causes of the Dutch 'Hongerwinter' of 1944:
Most of Holland was freed by the Canadians in '45 (fond memory of my father, 5yo at the time, of eating chocolate to the point of nausea).

Out of curiosity, when and where will you be speaking in Nijmegen? I am working at the st Radboud medical center in r&d of laparoscopic skills training, and would love your input on our program!

Paul Levy said...

3 April, but I don't know when. Please leave your name and email, and I will write back.