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Where did our common sense go?

Whole bureaucracies are built on the premise that people cannot be left to their own devices because they will do the wrong thing. And, to justify their existence, they will impose more and more rules, because not doing so might mean the end of the world for them.

By ROBERT HARDI Special to the Washington Post
Published March 13, 2007

Terrorists are everywhere! In San Diego recently, I went to the sauna at my hotel. I tried to move the little wooden headrest and a splinter got stuck in my finger. I asked the spa attendants for a needle to extract it. "Needles are forbidden," the pleasant lady in black and white informed me. For security reasons, she added. The manager confirmed this. After some negotiation and 15 more minutes, the security guard finally appeared, offering me some Band-aids and a pair of scissors, but no needle. He'd wrestle an intruder and would gladly take a bullet if somebody tried to shoot me, but he was not allowed to have a needle on his body.

Finally I asked if we could get one of those little mending kits, available in every room, that include needles. Housekeeping arrived after a while, and the splinter was extracted by one of the spa attendants whom I shamed into helping, against the rules of the place. She was a registered nurse and couldn't watch me suffer any longer.

This seems like another funny dinner party anecdote, harmless enough. Anybody with the slightest bit of common sense can just laugh at it. But is there anybody with common sense left?

A substitute schoolteacher in Connecticut inadvertently pulls up some porn on her computer and, although she attempts to shield it from the students, they get a glimpse of some unsavory action. She is tried and could be sentenced to 40 years in prison. Wouldn't somebody a generation ago just have told her to be careful not to do it again? But then what would prosecutors do?

I am a practicing physician. I wanted to try an experimental procedure at a local hospital. This was the end of a long series of trials supervised by the Food and Drug Administration, not some harebrained new scheme. Before going through the tedious process of approval by the appropriate institutional review board and committees, I asked the head nurse in whose department this experiment would take place her opinion. I told her that if she said she would object, I wouldn't waste my time and everyone else's in that review process. I have enjoyed an excellent working relationship with this lady for more than 20 years. Nevertheless, I was unable to get her to say anything at all, other than that this had to go through the appropriate channels. Absolutely, I said, but they will ask your opinion, so why don't you just let me know, and we can save ourselves a lot of trouble? Nothing doing.

"So what's the big deal?" you might ask. But not using our common sense and making up more and more rules instead is a big deal. It is pervasive and makes our lives a lot more unpleasant, unnecessarily complicated, less productive and ultimately less free.

Whole bureaucracies are built on the premise that people cannot be left to their own devices because they will do the wrong thing. And, to justify their existence, they will impose more and more rules, because not doing so might mean the end of the world for them.

Decades ago, hospitals got together to ensure quality and establish the Joint Commission on Accreditation of Healthcare Organizations. It was a great idea and it worked. Despite all the bad publicity doctors and hospitals get these days, life expectancy in the United States is going up, so we must be doing something right. Trouble is, what do you do after all the hospitals are inspected? Do you just disband or maybe downsize for future tasks? No, you cyclically reinspect hospitals, which is not a bad idea in and of itself. But to find new "rules" each time so that you can come back to see whether they are being enforced is another matter.

This can be quite absurd. I am a board-certified gastroenterologist. I used to be able to check patients in the hospital for occult bleeding with a simple rectal exam, putting a small stool sample on a test card and developing it at the bedside, looking for a color change. This is important information, easily obtainable. But no longer by me, because, under a recent new rule, gastroenterologists are no longer certified to judge the color difference. Does this make sense? Of course not. Can I change it? Apparently not, in part because making a common-sense argument is getting to be as strange as a $3 bill. Even smart, well-meaning people will kowtow to these rules rather than fight them with common sense.

When I first came to the United States more than 30 years ago from then-communist Hungary, I was struck by how Americans were willing to use individual judgment. They seemed to realize that rules were to be interpreted and not just followed with unquestioning servility. It was very different from the superregimented, state-controlled thinking of my country and I enjoyed it tremendously. It was this attitude that persuaded me to leave the place where I grew up and make the United States my home. It would be a shame to have to accept that the days of the "can-do" common-sense Yankee are over.

Of course, daily life still requires the exercise of common sense. As a physician, I have to make sensible decisions dozens of times a day. I still have hope that we can reverse this trend and realize, again, that if people are expected to use common sense, they may turn out to have some, and by practice acquire even more.

We may still be able to realize that by holding a steel fork to the carotid artery of a flight attendant, a terrorist could do just as much damage as by holding a knife, and we could do away with this nonsense of plastic knives on airplanes. Or maybe the ladies at the hotel in San Diego were right when they suggested that I should have just gone to the steam room instead of the sauna?

[Last modified March 13, 2007, 02:18:15]