Dr. Stephen Strange and Puzzles vs. Mysteries
Medicine is often referred to as an art and a science. This is based on the knowledge that there is still much we don’t understand about the inner workings of the human body, disease, and treatment. We need science to help us move from observation and questioning to hypothesizing, experimenting, analyzing, and making conclusions. This is the nature of science. Even when you don’t yet understand it, science is still science, and it gives us the confidence of solving the puzzles in medicine with clear conclusions and answers.
But what about the art of medicine? For anyone who has practiced, it’s undeniable that art will always be a part of medicine, because medicine contains mysteries. No amount of knowledge or understanding will remove mystery, and that’s one of the most fascinating elements of the pursuit of medicine. Unlike a puzzle, which has a single correct answer, a mystery is a problem where the answer can only be “correct for now” because there are innumerable conditions and interactions that can influence what the right solution is. With a mystery, as soon as you act on what you believe the answer is, the conditions change in a way that means the best answer changes. There’s no right answer, only the answer that is best in the current moment, under the current conditions.
The concept that some problems are puzzles while others are mysteries was first conceived over 70 years ago for counterintelligence training. Counterintelligence agents and analysts needed to understand that there are two types of problems to solve: ones with one right answer and others that continuously evolved and developed with each action taken in support of the “best right answer.”
Dr. Stephen Strange explains it in Avengers: Infinity War
Peter Parker: Hey, what was that?
Dr. Stephen Strange: I went forward in time. To view alternate futures. To see all the possible outcomes of the coming conflict.
Peter Quill: How many did you see?
Dr. Stephen Strange: Fourteen million, six hundred and five.
Tony Stark: How many did we win?
Dr. Stephen Strange: One.
Of course, our heroes do (eventually) win, but not in one of the 14,000,605 ways Dr. Strange foresaw, because defeating Thanos was not a puzzle with a single correct answer. It was a mystery, where each action the heroes took changed the future and the next right action.
An example of a puzzle is when cybersecurity teams want to know how many mobile devices they have that could be vulnerable to attacks. There is one right answer- the number of devices can be counted. That number may change frequently as devices are added or decommissioned, but the answer can always be found.
But that same cybersecurity team also asks questions that are a mystery. For instance, where is the system most vulnerable to attacks? They may agree that their servers represent a significant risk, so they better secure them. As soon as they take action to secure the servers, the answer immediately shifts. Now the system is most vulnerable to attack through their mobile devices. Eventually they will work through addressing all the areas of vulnerability that they can identify, and may even come back to servers as the area of greatest vulnerability as technologies and hacking evolve. This question is a mystery because there is never a single right answer- the process itself of finding and acting on the answer changes the answer.
The instability of the system- and the answer- has direct applicability to the art of medicine.
Diagnosis is a puzzle problem. When we want to find out what is causing a patient’s symptoms, there is one right answer. In rare cases there may be multiple diagnoses to be made, but there is still one correct, quantifiable answer.
Treatment is not a puzzle. A treatment that is working today may cause harm tomorrow. A patient might be stable on their blood pressure medication for years, but aging changes the situation and now that medication might contribute to a fall because the patient’s blood pressure is too low. The treatment that might be the absolute best for a condition may be too expensive for the patient. A patient with Type 2 diabetes may take weight loss seriously after starting insulin and lose 75 pounds, completely changing the course of their disease and treatment needs. Treatment happens in the real world where there are innumerable circumstances and interactions that can influence what the right treatment is. There is only the best option for right now, which is why treatment is a mystery.
Medicine is a science and an art, but perhaps more importantly, medicine is a series of puzzles and mysteries. When we fail to understand the difference, we create all sorts of issues.
For instance, technology and analytics solutions. Technologies that solve puzzles can’t support managing mysteries. And technologies that manage mysteries don’t solve puzzles. Programming a solution to find a single right answer is very different from programming it to suggest the next high quality action in the setting of evolving environments. Before building a healthcare technology, developers need to know if they are solving a puzzle or pursuing a mystery. Without this basic understanding, we end up with Watson, who is great at solving Jeopardy’s fact-based puzzles, yet failing when trying to address mysteries in healthcare.
What other areas do you see where we are failing to understand the nature of the problem and are creating solutions designed to solve puzzles when we need them to manage mysteries or applying solutions that can manage complex mysteries to simple puzzles?