Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Going Against The Conventional Ignorance – I

This is about an example of decision making in sports. No, I am not going to start commenting on sports regularly, besides the EMS relevance is in here, just farther down. I have not followed football since the 70’s. However, there is a lot of criticism of Sunday’s decision by Bill Belichick, coach of the New England Patriots, to go against what everybody knows and attempt to advance 2 yards and keep his team on offense.

One point about this is that punting the ball, in an attempt to give the opposing team worse field position, is really a defensive move. It is playing to avoid being beaten, rather than playing to win. A lot of people like this strategy of hoping to gain an advantage, then just trying to hold onto that advantage for the rest of the game. There is a word for that kind of attitude. That word is Loser.

The Freakonomics blog has several posts that address this way that peer pressure works in the NFL.[1], [2], [3]

One dim witted collumnist wrote, Mere mortals punt downfield and try to put as much real estate between their end zone and Manning’s right arm. Geniuses commit hubris instead.[4] As I mentioned, I haven’t watched football in a while, but I do know this. In the last 2 minutes of the game real estate doesn’t mean much. I remember watching the Raiders play the Jets. Somebody decided to cut to the movie, Heidi with just over a minute on the clock.[5] At the time, it seemed to be evidence that Senator McCarthy might not have been just another paranoid schizophrenic with too much power. It was only a case for the application of Hanlon’s Razor – Never attribute to malice that which can be adequately explained by stupidity. The last 2 minutes of a football game are not the same as the rest of the game. Perhaps the person cutting off the end of the game was the person who taught our myopic moron Borges all about football. Borges makes reference to the Twinkie Defense.[6] It seems more likely that he is smoking too much of his own product.

Remember, as long as you go along to get along, you will always have a place in the herd. Borges will have no shortage of muzzles prodding his anus in the conventional ignorance herd.

There are some sports commentators making positive comments about this deviation from the conventional ignorance.[7] I’m not claiming that the coach did not make mistakes. His punt team mindlessly headed out onto the field, although they were not directed to by the coach. The resulting confusion led to the use of the last timeout that the team had, a timeout that might have made a difference in the outcome of the game. That is a leadership issue. However, criticizing a leader, because the leader does not see things the same as an armchair quarterback – someone who would never be considered qualified to coach a team – that is not meaningful criticism of the leader. Leaders are paid to make decisions that do not even occur to armchair quarterbacks.

There is research on fourth down actions in the first quarter. This was in the fourth quarter, so the research is only passingly relevant to the current situation. The research shows that the odds are against punting. So why do so many coaches punt? Because –

If his team had gotten the first down and the Patriots won, he would have gotten far less credit than he got blame for failing. This introduces what economists call a “principal-agent problem.” Even though going for it increases his team’s chance of winning, a coach who cares about his reputation will want to do the wrong thing. He will punt, just because he doesn’t want to be the goat.[8]

It really isn’t any different from EMS. Just tell me what the protocol says. Thinking will only get me in trouble.

We have too many people in EMS more concerned about protecting their images than they are about protecting their patients.

We have too many people listening to the EMS conventional ignorance. If we are going to progress, we need to point out the flaws in their thinking. We have too many armchair quarterbacks and not enough leaders.

One writer explains the problem by imagining what it would be like if we did not have the burden of history encouraging this conventional ignorance.

Here’s a thought exercise for you. Imagine that for decades no one ever thought of the punt. Teams knew nothing else than to run or pass on 4th down. And then one day it’s invented. Some guy comes up to a coach and says, “Kick the ball on every 4th down and the other team gets possession 37 yards further down the field.” The coach would think he was crazy: “Wait, you want me to give up one quarter of my opportunities for a first down on every series…just for 35 yards of field position? Do you realize how much that’s going to kill our chances of scoring?”[9]

Maybe that is what we need to do with EMS. We need to imagine what would be our approach if we did not have this overwhelming history of conventional ignorance. If we did not have this pile of excrement for people to point to and say, Well, you can’t throw the baby out with the bath water. As if that had any meaning other than, I like it this way and I will throw a tantrum if anyone tries to change things. Tradition First – Patients Last!

Imagine if we approached trauma patients with the goal of decreasing their injuries, rather than increasing them by nailing them to a cross in a religious ritual that must be obeyed, or else conventional spinal immobilization. Imagine if we were to find a way to minimize the stress placed on a patients neck, rather than by creating an isometric exercise that encourages patients to use their neck muscles to strain against the Rube Goldberg immobilization contraption.

Imagine if we attempted to actually do what is best for the patient, rather than what is best for the protocol. This is the difference between playing to win (what is good for the patients) and playing not to lose (what is good for the lawyers, at the expense of the patients).

Imagine if we had protocols that put patients ahead of excuses.

Footnotes:

^ 1 When Economists Talk, Pulaski Academy Listens
By Steven D. Levitt
November 19, 2007, 11:10 am
Article

^ 2 Why Don’t Sports Teams Use Randomization? A Guest Post
By Ian Ayres
December 11, 2007, 11:34 am
Article

^ 3 Bill Belichick Is Great
By Steven D. Levitt
Freakonomics
November 16, 2009, 3:02 pm
Article

^ 4 Bill Belichick heads off victory – Bad bobble all around
By Ron Borges
BostonHerald.com
Monday, November 16, 2009
Article

^ 5 Heidi Bowl
Wikipedia
Article

^ 6 Twinkie Defense
Wikipedia
Article

^ 7 No problem with Belichick’s decision here
November, 16, 2009; 11:00 AM ET
By Mike Sando
ESPN.com
Article

I wondered which team was more nervous before that play. The Colts’ Peyton Manning had to be hoping the Patriots would punt in that situation because Manning had to like his chances with the ball in his hands.

and

In Belichick’s mind, then, the decision not to punt gave the Patriots a very good chance at winning the game. He played to win.

Punting with 2:08 remaining would have armed Manning with the football and one timeout remaining, plus the 2-minute warning. Going that route would have been playing not to lose. Good luck with that approach against Manning.

I won’t skewer Belichick for making a 2-yard bet on Brady just because he failed to collect.

^ 8 Bill Belichick Is Great
By Steven D. Levitt
Freakonomics
November 16, 2009, 3:02 pm
Article

^ 9 A New Study on Fourth Downs: Go for It
By Brian Burke
September 17, 2009, 7:00 am
The Fifth Down
The New York Times N.F.L. Blog
Article

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