Blog | Friday, September 14, 2018

TSA and the Quiet Skies Program: a lesson for doctors?

Consider these behaviors. A newborn calf nurses from his mother. A robin places a worm into the gaping mouths of her offspring. Cats know how to hunt.

These behaviors are examples of instinct. The creatures do not even understand why they engage in these acts. They are inborn behaviors.

Humans have instincts also. Unlike most professional standards and qualifications, instincts cannot be easily quantified or tested. But, under certain circumstances, they are invaluable assets.

We learned last week that the Transportation Security Administration (TSA) has been pursuing a program called Quiet Skies, when passengers who have met certain criteria are monitored for various behaviors that might suggest that closer scrutiny is warranted. I am making no comment here on the merits of the program, but I am supportive of TSA using instincts of air marshals as a tool to evaluate threats. Some have criticized this as an infringement on passengers who are not under actual suspicion or been charged with a crime. But, if we strip instinct and suspicion from the armamentarium of our security services, then what is it exactly that makes these folks actual professionals? Do we want “box checkers” or real pros?

Of course, most of the time suspicions will not be borne out. This does not mean, however, that the tool is invalid or that the target should feel victimized. Before, we cry “discrimination!”, let's consider what the stakes are here. This is not an improper search of your car trunk; it's blowing up an airplane.

I related to this issue since seasoned physicians rely so often on our instincts and sixth senses about our patients. Every physician has said or thought throughout his career, “something is not right here,” even if all of the objective data seem to line up. I think patients understand this and want their doctors to use their intangible skills along with their stethoscopes. Frankly, it is these skills, in my view, that are amply present in our very best physicians.

While you can't teach these skills, doctors over time do develop them. While younger physicians have much to teach us experienced practitioners, we have a few things to offer them, at least that's what my instincts tell me.
