but the patient died…

Posted on Wednesday 14 May 2008

Yesterday, I was looking up the military experience of Donald Rumsfeld in Wikipedia, and I ran across these two statements:
  • Following the September 11, 2001 attacks, Rumsfeld led the military planning and execution of the U.S. invasion of Afghanistan and the 2003 invasion of Iraq. Rumsfeld pushed hard to send as small a force as possible to both conflicts, a concept codified as the Rumsfeld Doctrine.
  • Following September 11, 2001, Rumsfeld was in a meeting whose subject was the review of the Department of Defense’s Plan in the event of a war with Iraq. The plan (as it was then conceived) contemplated troop levels of up to 500,000, which Rumsfeld opined was far too many. Gordon and Trainor wrote:
    As General Newbold outlined the plan … it was clear that Rumsfeld was growing increasingly irritated. For Rumsfeld, the plan required too many troops and supplies and took far too long to execute. It was, Rumsfeld declared, the "product of old thinking and the embodiment of everything that was wrong with the military."

    The Plan … reflected long-standing military principles about the force levels that were needed to defeat Iraq, control a population of more than 24 million, and secure a nation the size of California with porous borders. Rumsfeld’s numbers, in contrast, seemed to be pulled out of thin air. He had dismissed one of the military’s long-standing plans, and suggested his own force level without any of the generals raising a cautionary flag.
    In Rumsfeld’s final television interview as Secretary of Defense, he responded to a question by Brit Hume as to whether he pressed General Tommy Franks to lower his request for 400,000 troops for the Iraq War by stating:
    Absolutely not. That’s a mythology [sic]. This town is filled with this kind of nonsense. The people who decide the levels of forces on the ground are not the Secretary of Defense or the President. We hear recommendations but the recommendations are made by the combatant commanders and by members of the Joint Chiefs of Staff and there hasn’t been a minute in the last six years when we have not had the number of troops that the combatant commanders have requested.
They’ve stuck with me overnight [maybe until the end of time]. Three things bother me. First and foremost, the irritated sarcasm and contempt – "[that is the] product of old thinking and the embodiment of everything that was wrong with the military." The second is his self-righteousness – he was so cock-sure he was right that anything anyone said was discounted at the least, or worse, angrily devalued. The third thing is striking in the face of the first two. He never authentically took responsibility for anything.

The idea he’s attacking when he says "old thinking and the embodiment of everything that was wrong with the military" is a concept that says instead of using a strong ground force, you send out small mobile forces who call in air strikes when they encounter resistance. It’s a perfectly reasonable strategy if the enemy is identifiable and separated from the civilian population. Neither of those things were true in Iraq, and that was infinitely predictable. It was also something that would show quickly during combat. In practice, it has been highly ineffective in Iraq, resulting in an unacceptible level of collateral damage [mothers, children, old people, allies, innocents] with little military gain.

It reminds me of a situation I actually know something about – medical errors. It is impossible to know all of medicine. It’s impossible to even know most of medicine. So the salvation of the physician is to learn to know when you don’t know something. If you know that you don’t know, then you can find out – look it up, ask for help, all the ways one can fill the hole of not knowing. Often, mistakes are the rule. Recovering from the mistakes quickly is what saves the day. Physicians are seen as experts and often seen as arrogant, which many are. Arrogance is a wonderful defense against fear and insecurity. But the most important quality to look for in your physician is humility – a willingness to be wrong, asnd make mid-course corrections.

Where I’m headed here is obvious. The term "hubris" is often used to describe the Bush Administration [It was even a book title]. Hubris is the opposite of humility. In these examples, Rumsfeld has heard a concept that he turned into a doctrine. There’s nothing wrong with the concept, provided it’s implemented in the context in which it was developed. But, Rumsfeld is applying it as if it were a general truth. That’s what "rookies" do – grab onto some simple idea and apply it everywhere. But worse, he doesn’t listen when people in the know, e.g. veterans, try to tell him he’s wrong. And even worse, when it becomes grossly apparent that he was wrong [the Insurgency], he didn’t change courses. And even worst, in retrospect, he doesn’t even acknowledge that he was the motor that ran the boat that went aground and sank.

He could have redeemed himself at any time and come out okay, but that never happened. Examples of this particular kind of error abound in the Bush White House. Cheney, Rumsfeld, Bush, Rice, all went down the same path, arrogantly holding on to ideas that they rode straight to the bottom. In medicine, we say something like, "yeah, you were right, but the patient died" when a colleague has made a categorical error – chased and defended a wrong diagnosis to "the death."

Two asides: John Yoo speaks to this in his interview with Esquire when he talks about what happened with his Memos. And Douglas Feith addressed it when he tried to talk Jon Stewart into believing that the Administration made errors, but didn’t tell lies. Neither, however, seemed to grasp that the things they did had disasterous consequences that weren’t corrected along the way. And neither of them seemed to notice that they, themselves, did nothing to steer things back on track. Like Rumsfeld and Cheney, both of them were stuck on the rightness of their wrong ideas, rather than re-examining them to see why they had such disasterous consequences. In medicine, it’s called an autopsy

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