Part of healthy living and certainly a significant part of longevity is found in the making of sound judgments and right decisions.  The problem with life-changing actions is that we often make decisions on the basis of inadequate information.   In his business book, The Fifth Discipline, Dr. Peter Senge at MIT addressed “dynamic complexity,” which he defined as, “where cause and effect are subtle, and where the effects over time of interventions are not obvious.”  The cause of a stroke began thirty years before the catastrophic event.  Effective treatment of the stroke would have been prevention: control of blood pressure, exercise, weight and not having started smoking years before the effect of the neglect of one’s health was known.  Because the cause did not hurt, it could be ignored until it was too late.

The following are elements of “dynamic complexity”:

• “When the same action has dramatically different effects in the short run and the long run, there is dynamic complexity.
• “When an action has one set of consequences locally and a very different set of consequences in another part of the system, there is dynamic complexity.
• When obvious interventions produce non-obvious consequences, there is dynamic complexity.”

While written about “systems thinking” in business, these principles also apply to our health and to healthcare delivery.  When we are making life decisions, we often make them on the basis of immediate gratification without regard to the consequences of those choices over a long period of time.  We do what “feels good,” or what is “fun” now, without considerations of how it will affect our future. 

Making healthy choices based on sound judgment requires that we look beyond the moment.  We want to avoid high blood pressure, diabetes, or heart disease.  That requires that we make decisions today which will make a difference in our lives twenty, thirty, or even forty years in the future.  Once the effects of wrong choices come upon us, we can treat the problems but most often we can’t cure them.   And, while may people have diabetes due to no fault of their own, the best way to treat diabetes is still, “Don’t get it!”

Unintended Consequences

One thing I have tried to teach my grandchildren and which I taught my children is the concept of “unintended consequences.”  Many lives are permanently damaged as the results of acts where no ill intent existed.  Practical jokes and bravado challenges result in injury and even death when the only intent was to amuse or entertain. 

Let me give you an example.  When I was a child, friends from “down the road” visited one day. While the adults where in the house, the children played out side.  One of the games was played by the older children laying on the ground and letting the younger children sit on their feet.   The younger children were then thrown into the air. It was great fun and everyone laughed, until one of the younger children lost his balance, and in the fall, broke his wrist.  As children, we were unable to think beyond the amusement to the potential risk, which was significant.

Several years ago, I arrived at one of SETMA’s clinics early in the morning.  I found a possum outside our building and caught it.  I desperately wanted to tie it under our COO’s desk.  A possum can’t really hurt you but it can “scare you to death.”  When my thoughts went to the potential consequences, I realized that I could not pull this prank because I could not control the outcome. I realized that while it was highly unlikely that it could “scare a person to death,” but that if it did, there is no recourse to that.  It is also possible, improbable, but possible to get an infection or other harm from the prank.  Therefore, I had to enjoy the idea without the act.  The contrast between these two events is the difference between a child’s judgment and that of an adult. 

Child Brain Development

The Insurance Institute for Highway Safety showed that teenagers are four times as likely to be involved in a car crash and three times more likely to die in one than adults. Recent studies have shown that these statistics may have to do with teenage brain development.   A National Institutes of Health study proposed that the part of the brain that restrains risky behavior, including reckless driving, and thinking skills is not fully developed until the age of 25.

The psychiatrist leading the study said that this finding came as a surprise to him because he used to think that the brain was fully developed by the age of 18.   The study used magnetic resonance imaging (MRI) to scan 2,000 people’s brains every two years. It has been found that teenage brains have extra synapses in the areas where decision making and risk assessment take place. Most of these synapses are useless and even get in the way of one’s judgment. Eventually, as teenagers become adults the synapses disappear, but the findings imply that many life choices are made before the brain’s decision making center is fully developed.
Choices, decisions and judgments have consequences.  If we are going to live well, we must be aware of the unintended consequences of our choices.

Unintended Consequences

There is no better illustration of this principle than the recent tragedy of a nurse who took a prank call from an Australian radio station.  The nurse apparently hanged herself using a scarf.  Jacintha Saldanha was found hanging from a wardrobe door at her hospital living quarters. 

The nurse put through the prank call December 4 to a nurse on the ward where Prince William's wife, Catherine, was being treated for acute morning sickness.  Some details of her condition were given to the radio DJs, who impersonated Prince Charles and Queen Elizabeth II.  The DJs did not intent to harm the nurse, or anyone else but their lives are forever changed by this incident and the nurse is dead.

Don’t Move Until You See It

One of my favorite movies is In Search of Bobby Fischer.  The story is about a child chess prodigy.  His mother wanted him to be kind and his father wanted him to have a competitive instinct which “moves in for the kill” in a chess game.  As the child played for the national chess championship, he and his competitor were alone in an auditorium and the families and others watched on closed circuit television.

At a critical moment his chess coach, played by Ben Kingsley, said, almost to himself, “It’s there; it’s six moves away, but it’s there; don’t move until you see it.”  The father eager for the win, anxiously said, “What’s there?”  The coach continued to say, “Don’t move until you see it; don’t move until you see it.”  The father was going berserk wanted to know “what is there?”  Finally, Kingsley said, “He sees it!”  The father shouts, “What does he see?”

At that point the chess genius does the most improbable thing; he reaches his hand across the board and offers it to his opponent.  In chess that is the offer of a “draw,” both players “winning.”  The opponent, not seeing what Kingsley’s student saw, said, “What?”  Our young prodigy said, “You have lost; let’s share the prize.”  This dialogue followed:

“Draw? You've got to be kidding.
“You've lost.  “You just don't know it.
“I've lost?
“Look at the board.
“I have.
“Take the draw, and we'll share the championship.  Take the draw.
“Move.

Two quick moves and the opponent “sees it.”  He knocks his king over, acknowledging his defeat.

The Lesson for Us - Don’t Move Until You See It

The lesson for children and adults, a lesson which is too late for the disc jockeys and for the nurse, is to “not move until you see it.”  Don’t make a life decision until you examine the potential outcomes which are not your intent but which are possible and which you cannot control once you take the first step.  Before you act, take a moment to think about all of the consequences - those you intend are immediately obvious, but think about the things that “could” happen beyond what you intend.

• Do you think that the drivers of over 100 vehicles on I-10 last month “intended” to wreck their cars?  Of course, they didn’t but when they failed to slow down when the visibility was so poor that they did not have time to stop, they set in motion actions which had consequences the drivers would never have chosen.
• Do you think those DJs want to hurt the nurse who took her life?  Of course they didn’t but they will not be remembered for their clever prank but they will be remembered for the unintended consequences of their act. They moved before they could see the consequences of their act.
• Do you think the husband who in a careless moment betrayed his marriage vow, intended to destroy his family?  Of course, not, but like we were as children, our amusement (remember the origin of the word - “a” which means “without” and  “muse” which means “thought”)obscures the consequences from us.  The husband did not look at what the consequences of the next move would be in six moves.
• Do you think that all residents of death roll set out with the intent of murdering someone?  Often they started an act of lesser seriousness which escalated into a capital offense.  (By the way, I am against the death penalty.)

In life and in health, just remember; don’t tie the possum under the desk unless you can control all of the potential consequences.