Thinking Around Corners: The Black Swan, May 2020

Last month I introduced the concept of learning to “think around corners”; and, how my expertise as a practicing neurosurgeon didn’t necessarily prepare me well for the career transitions I made over the past decade of my medical career. Perhaps I relied too much on my clinical experience and pattern recognition to “predict” what might, in fact, be an “unknown unknown” in a diagnostic or treatment dilemma. Usually my training, compulsive attention to detail, and domain expertise would give me solid guidance in my clinical decisions…but when it didn’t, I became confused, disoriented, and very uncomfortable. I believe that many physicians are meeting “The Black Swan” for the first time in their careers; and, this experience may change how they view themselves and their careers forever.

A Black Swan event is an unexpected and unknowable event with severe negative consequences that is later assessed and rationalized by pundits as having been entirely predictable. We are beginning to see the toll the Corona Virus pandemic is taking on patients, healthcare systems, governments, businesses, and the public…so, for purposes of my blog series, “Thinking Around Corners”, I am interested in the disruptive impact of this pandemic on physician practice, and specifically, the challenges facing physician leaders going forward.

Much to their surprise, many physicians are facing employment and financial uncertainty as their practices are closed, elective surgery postponed, and office visits cancelled (by government mandate or patient request). For those working in “hot zones”, with exposure to a lethal pathogen without adequate protective equipment, supplies, and medications to properly care for critically ill COVID-19 patients; they may feel a real threat to their (and their family’s) personal safety. There are very few aspects of this event that were predictable at this point in time…and I am not going to fall into a retrospective trap trying to predict all of the potential outcomes from this event on physicians’ careers. I think that it would be fair to say that their experience during this difficult time will inform, and likely change, their view of medical practice, career stability, and professional goals going forward. The US Military Special Forces are working to train their leaders to expect to perform in an environment of volatility, uncertainty, complexity, and ambiguity (“VUCA”). Perhaps, from a “Thinking Around Corners” standpoint, the traits of resilience and adaptability may become just as important to future success as historical specialty domain expertise in the new post-COVID-19 medical care environment…”how you think” will be as important as “what you know”.