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Two days after Halloween, I met with Dr. Bill Bornstein, Chief Medical Officer and Chief Quality Officer at Emory Healthcare. \u00a0I am a cultural anthropologist who has been conducting field work at Emory University Hospital (EUH) for three years, and Dr. Bornstein and I meet monthly to discuss hospital culture, specifically that of the operating room. \u00a0I asked him if I could write about Emory\u2019s experience with Ebola, and he said yes but was curious about my angle. \u00a0I said I was unsure.<\/p>\n
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Before leaving, Dr. Bornstein asked about my Halloween. I told him I went as Natalie Portman\u2019s black swan. \u00a0He replied, \u201cHave you ever heard of Nassim Taleb\u2019s Black Swan Principle?\u2026\u201d He explained that people once believed all swans were white, and had never conceived of a black swan simply because no one had ever reported seeing one. \u00a0The metaphor suggests that we have endless assumptions about finite evidence. \u00a0Outliers are rarely predicted, but always seen in hindsight as glaringly obvious. \u00a0Dr. Bornstein and I locked eyes and smiled, knowing I\u2019d found my angle.<\/p>\n
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The Ebola virus was named the Lingala word \u201cEbola,\u201d or \u201cBlack River,\u201d for a waterway near where it first surfaced. I sought to understand how Emory predicted the black swan that had emerged from the Black River. \u00a0However I soon learned that it didn\u2019t–the isolation unit, or what its associate director Angela Hewlett calls the \u201cConcrete Box,\u201d was built with tuberculosis in mind, not Ebola. \u00a0But it wasn\u2019t because of luck that Emory has been able to successfully treat four Ebola patients. \u00a0The M.O. of Emory Healthcare is that it\u2019s better to be over-prepared than underprepared. \u00a0This had me thinking–has paranoia been key to the survival of our species, and will it ultimately cause our demise?<\/p>\n
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When I conduct behavioral observations at hospitals, my research subjects–the clinicians, not the patients–understandably wonder if there\u2019s a chance I\u2019m going to ultimately get them into trouble. \u00a0I am often called \u201cthe spy\u201d and sometimes \u201cthe interloper.\u201d During the height of the recent media frenzy over Ebola, I was once called \u201cthe Liberian.\u201d In what seemed like every surgical procedure I observed, clinicians were agonizing over other people\u2019s stressing about Ebola. Despite being in the same hospital as the disease, I didn\u2019t overhear a single conversation about Ebola in the operating room. Maybe EUH wasn\u2019t paranoid?<\/p>\n
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When Thomas Eric Duncan died in Dallas, my postdoctoral advisor, primatologist Frans de Waal, and I had a few impromptu conversations about empathy and socieoeconomic status. \u00a0Never a light discussion, it definitely wasn\u2019t so with the man who has repostulated our understanding of the evolutionary foundations of morality (they\u2019re not in humans).<\/p>\n
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This led to a conversation with Emory Healthcare President and CEO, John Fox, about empathy in the medical community. \u00a0When I asked if he\u2019d lost any sleep in recent months, he said generally no. \u201cI think we did the right thing by our mission and values. \u00a0[We asked ourselves two] basic moral ethical questions. Can we do it better than the alternative? …Can we manage it [and keep our community safe]? He continued, \u201cWe adopted the highest standards from day one. There were ideas and discussions of adopting lower standards; we had people who said we could do this more cheaply … We just said no. If we\u2019re going to err, we\u2019re going to err on the side of being too cautious. I said it very clearly–this may have a bad outcome. We have to be able to accept that.\u201d \u00a0So from the operating room to the executive suite, there was a sense of responsibility and confidence at EUH that the rest of the country seemed to lack.<\/p>\n
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\u201cThe media attention was off the charts,\u201d President Fox lamented. \u201cWe thought it would be X. turned out to be 10X. \u00a0It was major sideshow [on campus].\u201d \u00a0He explained a few of the public\u2019s divergent perspectives, \u201cSome had a vision of the Ebola patient coming in on a concourse at Hartsfield, getting off the plane , getting on the trains, sitting there at baggage claim, and getting in a cab and then coming here.\u201d<\/p>\n
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The public imagination is boundless. It hungers for black swan stories and even apocalyptic plagues. We have become what sociologists Anthony Giddens and Ulrich Beck call a \u201crisk society.\u201d I call it an \u201cobsessive-compulsive\u201d society. \u00a0As both a social scientist and someone who has been professionally diagnosed with mild OCD since childhood, I do not apply the label lightly. \u00a0One of the ways I have managed my tendency to speculate ad nauseum is to stop ingesting sensationalism. \u00a0Simply by replacing toolbar links to websites that cover celebrities and shootings with those that feature healthier interests, like discoveries in archaeology and neuroscience, I have stopped visiting the damaging sites altogether.<\/p>\n
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People are always surprised that as an anthropologist, I work with hospital executives. \u00a0I give major credit to these leaders, especially Director of the Emory Center for Critical Care Dr. Timothy G. Buchman, for understanding the need to explore the culture of biomedicine, and the broader culture in which we practice biomedicine. \u00a0Emory may not have been able to predict the black swan from the Black River any better than anyone else, but the hospital understood that Ebola does not mean the Black Death. \u00a0It was prepared but not paranoid, unlike the unprepared and paranoid public. \u00a0Rather than entertaining irrational fears and compulsively consuming news that exploits those fears, we need to look to intelligent, informed leaders like those at Emory Healthcare–who prepare for the worst but expect the best.<\/p>\n
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Laura Kathryn Jones, PhD<\/p>\n
Postdoctoral Fellow<\/p>\n
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Emory University<\/p>\n
Department of Psychology<\/p>\n
36 Eagle Row<\/p>\n
Atlanta, GA 30308<\/p>\n
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lkjones@emory.edu<\/p>\n
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Two days after Halloween, I met with Dr. Bill Bornstein, Chief Medical Officer and Chief Quality Officer at Emory Healthcare. \u00a0I am a cultural anthropologist who has been conducting field work at Emory University Hospital (EUH) for three years, and Dr. Bornstein and I meet monthly to discuss hospital culture, specifically that of […]<\/p>\n