"Hey boy", it's a system, not the part

A recent episode in our family got me thinking on what specialists do and what it takes to be a special integrator of specialisms.

An 87 year old was on nebulized anti-asthma medication for more than 3 months. He was a patient for 30 years now. The junior specialist made preliminary recordings and presented him the quaternary specialist. “So, why is he still suffering?” challenged the venerable senior. Not a murmur nor a response from the junior.

Then suddenly one day, the octogenarian noticed swollen legs. After a couple of general physicians on his cultivated network of doctors saw him, he was taken between raising his legs between walks and cushioning them in elevation for sleep. He even took to changing his footwear. Despite intermittent relief, the signs became more ominous. A band of clot along his soles.

Then we took him to the neighborhood general physician. He paused between reports, asked his nurse to set up an ECG and examined him personally. “No problems at all with your heart. But you need to restrict your water intake. Reduce your fluid to no more than 1 litre a day, and have these medicines for a week. You will find the swelling subside and your asthma much relieved – maybe 60% to 70% relief from the medication you are taking now. You are probably addicted to them at this age, so you decide when to reduce your nebulization and let us review after a week.”

And what about diet? “Just avoid bananas and brinjal for a week and let us see”.

Within 4 days, he had reduced asthma puffs to one third, and the swelling gone. No yearning for water either and his sleep calmer and more uninterrupted too. On review the doctor said “Your vessels feel the pressure to pump back and forth at your age, and the kidney needs to expel slightly elevated creatinine. That’s why when you lie down the legs were pushing fluids back to your lungs. Now the lungs sound at least 50% better, because it's expelled water. Your rales and wheezing are also down. Expect further reduction in about a month now, and you will be much better on asthma”.

In the 3 months of extensive nebulization, the patient had almost lost his voice. The ENT specialist attending on him explained that the sprays and puffs had deposited bacteria on the voice box, and the stroboscope clearly showed that in vivid color! What the patient could not sense and realize for himself, the integrated diagnosis of the general physician could. The patient is clinically relieved and psychologically confused as to what did the patient do wrong in selecting the earlier doctors?

This is what cognitive biases do. They refer us to the more ineffective solution. Socialization repeats the error ad nauseam. And the more specialists disengage with the rest of the system, the more illness in the bodies of unsuspecting patients.

A system is indeed more than the sum of its parts. Just as our human body.

When HR is referred to a compensation specialist or a T&D specialist or indeed a Diversity and Inclusion specialist, what prevents us from the integrated view of the employee? Of the function and of the organization? Of the network of institutions in its ecology?

Watch the most wise teacher of Systems Thinking call it out, on why taking a best practice or part from one system and assembling it in another may not get us the whole we conceive in assemblage. Aggregation is seldom synthesis. Russel Ackoff is brilliantly engaging in this video.