“The task is . . . not so much to see what no one has yet seen; but to think what nobody has yet thought, about that which everybody sees.” – Erwin Schrodinger

My wife asked me to fix the kitchen faucet.

Did you know that faucets, especially the one at your kitchen sink are rather complex pieces of engineering?  I learned yesterday that behind the polished chrome are all sorts or tiny pieces, several of which, if you do not know ahead of time are there, can easily make their way into the drain that contains the garbage disposal.

About fifteen minutes into the process I got a somewhat Edisonian moment.  We have two kitchen sinks and two identical faucets.  Faucet number two would be my safety value, my manual for figuring out how to reassemble faucet one.  Or so I thought. 

Two hours had passed. Glasses and plates were beginning to pile up on the counters.  My wife was kibitzing from the sidelines.  Apparently she knew something I did not know about what it was she told me to do. 

I operate on very few rules.  One of them is that you can tell me what to do, or you can tell me how to do it, but you cannot do both.  If you know the what and the how then I am superfluous and you can fix the faucet.

I soon reached the point where I announced to my family, pack your things; we are selling the house…

…I have become quite a fan of Breaking Bad.  One of the givens in the show is that whenever two stakeholders are involved one knows something the other one does not know.  Sometimes the audience knows something the actors do not know.  Sometimes the actors know something we do not know.  Usually one of the actors in the scene knows something the other actor does not know—kind of like fixing the faucet.

We are living in the age of string theory and god particles.  No two people operate on the same knowledge, nor can one person have an understanding of all of the issues and solutions.  Forests and trees.  We are tree people or forest people, and when one from each camp jointly evaluates an issue—I am a forest person—you are left with a faucet, though shiny as it may be, it may never again deliver water.

What that guarantees is that one or both of the people will stand firm on the notion that whatever it is that the other person is proposing cannot be done.  Everything can be done—string theory and god particles.  Loosely translated, and what the person across from you is trying to say, is either I do not know how to do that, or somebody is going to ask me why I did not think of that idea.

What I learned yesterday from the faucet debacle is that there will come a time when being a forest person will never get you the water you need to make a cup of coffee.  You may have a notion of string theory that you can espouse deftly on the back of a napkin to a librarian, but you could never get it sorted out to the point where you could explain it to a physicist.

Sooner or later somebody needs to ask the question What do you think?  Sometimes we need to recognize that the copse of trees in which we are standing is but a subset of the forest.  Hospitals are so focused on HCAHPs (the copse of trees) that they have lost sight of the forest.  We made sure our people know everything that can be known about tree bark. But we have trouble seeing beyond that tree.

Having singular knowledge is a great skill if you happen to be worried about elm blight—one species of tree amongst dozens of species in the forest.  It is worth little if your mission is to improve the health of the forest.

If responding to CMS—think HCAHPs—is what is keeping you awake at night you should consider taking a Benadryl.  This forest/tree conundrum is the penultimate elm tree versus national forest.