I’ve been thinking a lot this week about Dr. House and the differential diagnosis in organizations. For those who aren’t familiar with the character of Dr. Gregory House, he is the cantankerous diagnostician of the eponymous television medical drama. He limps along with a cane and pops Vicoden as if they were Skittles. Each episode features a baffling medical case that endangers the life of the patient. House’s staff wrestle with the problem, proposing and rejecting diagnoses until House, having heard enough, insults them, correctly identifies the malady, prescribes a treatment, and saves the patient’s life.
Two brief observations before I explain what House has to do with organizations. First, living in Europe has made me value little slices of home, usually in the form of enchilada sauce or a little bad TV. Second, House is premised upon Dr. Lisa Sanders’ “Diagnosis” column in the New York Times Sunday Magazine, a longtime favorite. Those influenced my fandom.
House episodes are formulaic: they begin with a dramatic medical event, shift to the doctors discussing the symptoms, and continue until the patient is cured (or dead). The core of the series–and the column that inspired it–is the “differential diagnosis”.
Differential diagnosis is essentially a process of elimination. House writes the symptoms on a whiteboard and the team works through the list of possible diagnoses until all but one have been ruled out. There are occasionally multiple diagnoses, but the momentum is toward finding the one most likely cause that explains all the symptoms. The initial diagnosis often proves false, necessitating further elimination to get the correct diagnosis. This process is the heart of the show.
Contrast this with diagnosis in the organizational environment. For most practitioners engaging with organizational matters, the patient tends to self-diagnose before the practitioner shows up. In many cases, treatment for the self-diagnosis has already begun. Leaders in organizations are often highly resistant to having their self-diagnoses second-guessed.
What happens when patients self-diagnose and self-medicate on House? They usually get it wrong and often make the illness worse. What happens when leaders do their own diagnostic and prescriptive work? Pretty much the same thing.
It should go without saying that an accurate diagnosis is a prerequisite to proper course of treatment. It should probably also go without saying that inaccurate diagnoses cure by luck, do no harm at best, and most often create more problems than they solve. All of that should go without saying, but it does not and cannot.
Social sciences and physical sciences are not the same, as physical scientists are fond of reminding social scientists. To say that an organization and a medical patient are the same would be absurd, but to say that there are no commonalities would be equally preposterous. It should be logical to begin any organizational treatment with a solid diagnosis, most likely one that follows the process of the differential diagnosis. In practice, diagnoses are far too often absent or facile.
Dr. House suffers from pain and from the tendency among those around him to jump to the easiest answer. Too many of his peers approach medicine with whatever specialty they embody. Surgeons want to cut, GPs want to write ‘scrips. Perhaps org change practitioners would benefit from the differential diagnosis process. Perhaps their clients would get better health care. Timely, no?