We’ve been drawing the wrong lesson from the Boy Who Cried Wolf

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Mrs. Malik was 71 when she learned how to recognise the signs and symptoms of a stroke. She learned this from a series of pictures on a local hospital’s information leaflet. On the top banner, in blazing red ink, was the hospital’s emergency number that could be called if one were convinced that they were having a stroke. “Don’t hesitate,” it said. “Just call. We’ll be there in 10 minutes.”

Mrs. Malik carefully folded the paper till it showed just the emergency number and taped this to the landline phone set she used. She further wrote the number down in her personal phone diary, and made a mental note to ask someone to save the number in her cell phone.

Two days later, the ambulance was at her doorstep.

She was taken to the hospital, where after a brief examination, the doctor told her that she was fine. It wasn’t a stroke. There was nothing to be worried about.

Over the next seven weeks, the ambulance came to Mrs. Malik’s place four times. And each time, the doctor assured her that it wasn’t a stroke and she had nothing to worry about.

The sixth time she called the hospital, though, the lady on the other end asked Mrs. Malik, with a touch of irritation in her voice, “Are you really sure?”

Mrs Malik wasn’t. She had been feeling guilty about calling the ambulance for nothing, but she was also scared she might be having a stroke. “Please, it is an emergency,” she said into the phone.

The ambulance did not come that day, not until much later, when the neighbour found Mrs. Malik collapsed on the floor. Thankfully, she has made a full recovery now, but she could, so very easily, have not.


The Boy Who Cried Wolf

Now, you might be thinking that this is so very different from the story of the Boy Who Cried Wolf.

That boy cried “Wolf” to the village every day because he thought it was fun to see if all the villagers would gather together with pitchforks and staves and wooden mallets to save his sheep. And if they did, the Boy could laugh at their expense.

He was naughty and was doing it just to inconvenience everyone. He didn’t care about the time and trust of the villagers and he insulted them for being helpful.

He deserved what came his way. He deserved having the Wolf eat all his sheep.

But Mrs. Malik didn’t call the hospital with malicious intent. She didn’t call to see if the ambulance would come. She didn’t call to inconvenience the people at the hospital. So, how is this about the Boy Who Cried Wolf?

Well, let’s look at what the lady on the telephone had to say about the event later during an investigation. I have translated it from Odia and paraphrased it.

I have known Mrs. Malik for a long time now. She comes to our hospital for checkups every few weeks, complaining about all the symptoms she thinks she is having. Every single time it turns out that she is just making these things up. And then she just hangs around for a bit, talking to the staff here about the doctors not knowing what they are saying.
She lives all by herself, and her son doesn’t keep in touch. So I think she just comes to the hospital because here we talk to her. But we are not an old-age home. We are always busy. We have so many real patients to take care of.
She had been calling our new emergency stroke hotline number time and again. I think she read our leaflet and convinced herself that she had this issue too. We rushed to her house every single time, and each time it turned out to be nothing. That day when she called, I thought it was just like that.
All our ambulances were already out picking up other patients and I was waiting for one of them to come back, as I had another place to send it to. So, I prioritised that over this. I really didn’t know she was actually having a stroke. It had never happened before.

To this lady, Mrs. Malik was a lonely old woman who kept bothering the hospital because she wanted attention. To this lady, Mrs. Malik was making symptoms up in her head and was not respectful of the hospital’s time or readiness to help. To this lady, Mrs. Malik was the Boy Who Cried Wolf.


Whose fault is it really?

The hospital management claimed that it was an individual employee’s fault. That it was a “grave error of judgment.” But how was it that the hospital allowed this employee the freedom to choose whether to respond to a call or not? Was the lady not required to send the ambulance, no matter what she personally thought about it?

The lady in question has this to say:

I have been in this hospital for over seven years now. I have a nurse’s degree and I have worked as the head nurse in the out-patient wing for two years. When they set up this new hotline, they trusted this job to me because I was the senior-most staff member.
It is an important job, because we have only three ambulances. And running them is expensive. So, my bosses told me to choose wisely whenever I despatched one to someone’s house. They trained me in knowing which cases need an ambulance and which don’t. When to send the ambulance and when to advise the callers to come to the hospital on their own vehicles. I have never sent an ambulance without judging whether the trip is really needed or not.
The patients should also understand that this is an important phone number and not for joking around. They should call this number responsibly. Even the leaflet says that you should call only if you are convinced that it is a stroke. People think we are a government hospital with crores of funding coming to us. If they want help for every little thing, they should rush to the government hospitals.

The Wolf didn’t eat all the sheep because the Boy was a liar and menace. It did so because the villagers heard a cry of help and chose not to act on it. Mrs. Malik was left collapsed on a floor, not because she was an irreverent caller. It happened because the hospital had given the lady on the phone the freedom to hear a plea and choose not to act on it.

In both cases, the people thought that they knew what was going on, they thought that they were right to do what they were doing and they thought they could just ignore the cry, even if it was of emergency. And by thinking so, they allowed a disaster to happen. A disaster, which could have been very easily avoided.


The Systems Design lesson from the Boy Who Cried Wolf

When we tell the story of the Boy Who Cried Wolf to little kids, we think we are telling them that lying is bad. That being disrespectful of people’s intention to help is bad. That doing these things would bring trouble on to their own heads.

Yes, it is an important lesson for kids to learn. And I totally agree that it should be brought across to them. But there is also another hidden message that we don’t want to send.

When we tell this story, we tell them that our care and protection is very conditional. We tell them that if they are naughty, they are on their own. If they lie, we will abandon them. And if something bad happens as a result, it will be their fault, not ours.

Similarly, when hospitals open up emergency lines and assign an individual to make a judgment on whether the emergencies are worth their attention, they are telling us that we are not really safe calling them. That they will come to our rescue only if they feel we are really in trouble. Or if we are model patients.

And this happens everywhere. Organisations routinely claim that their technology systems are designed to eliminate Type I errors and accommodate Type II errors. That is, they are designed to accommodate any number of false alarms, but they will never ever let even one real alarm go unheeded. And yet, their human systems aren’t designed to hold up their claim.

Companies set up customer service numbers, telling everyone to call them 24×7, but each time a call comes through, a company man has the power to judge whether to act on the request or not.

Human Resources departments stick posters in cubicles claiming they are open to all suggestions all the time, but an executive routinely ignores the email coming from the “cry baby in operations department” because it’s not really worth their while to pay attention to the little things.

The lesson is simple. As communities, as companies, as institutions, we want to tell our people that they are safe with us. That they can rely on us for every little thing. And to do that, we have to be ready to act on every single call from them. Even if they have a record of misusing it or being disrespectful of it.

Because safety is not conditional. Safety is something people should take for granted. All the time. And that is why we need to work extra hard to make it so.


If you found this article useful, please share it with others.

And if you have told your parents or partners that they can reach out to you anytime, don’t stop to think if it’s really really important when you hear the call. Just pick it up.

Originally published in Between Strides on January 2, 2017.

One thought on “We’ve been drawing the wrong lesson from the Boy Who Cried Wolf

  1. A friend made the following point:

    “You heard the part where the hospital had limited ambulances and resources to operate them. In such cases 6th call when the first 5 calls were incorrect (not malicious) it seems like a pattern and the thought process is to prioritize the resources for those who actually need them.
    the lesson over here is actually not to jump the gun and be reasonably certain of symptoms b4 invoking emergency protocol. The lesson is also the callousness of the society to let an old woman live alone. But any and every logistics problem with a case of limited resources will De-prioritize something that has a history of multiple past failures. Unless you have Ambulances to spare. That is the only way you can prioritize cases. It may be unfortunate but what happens if the Ambulance ignores a young boy to get to Mrs. Malik for the 6th time and found no issue?
    The only reason the society could be blamed for is not having enough resources. Not for not choosing to care but for prioritizing something else looking at past data.”

    My response to that:

    “I have nothing against priotising, as long as they are transparent about it. And I have nothing really against the lady on the phone. She was doing her job just as was expected of her. My contention is with the hospital policy.

    You can’t make a claim of saying you will be there in 10 minutes, if you don’t have the logistical capacity that can support that claim. And if you make the claim, you have to forego the excuse of not having enough resources.
    The hospital could have said, “We will come ASAP.” Or, the hospital could have sent an ambulance as soon as one was available. They didn’t send any at all. Was a call that came an hour after Mrs. Malik’s call more urgent than the one she made?

    An ambulance was never sent because they had dismissed her call altogether. She wasn’t put on a waiting queue, she was thrown out of the consideration set. I have a problem with this way of doing things. Especially when it’s a case of life and death.

    Regarding the lesson about being sure of symptoms before initiating emergency protocol:
    When a person starts feeling like they are getting a stroke, they aren’t in a state of mind to make a rational decision about it. Nor are they experts at understanding how stroke works.

    There have been thousands of reported cases where a person did not call an ambulance because they thought it was just chest pain or temporary discomfort. And those people suffered as a result. There are also cases of casualties.
    Medical experts have almost unanimously agreed that whenever a person has even a shadow of doubt about a thing like stroke, they should rush to a hospital. Because strokes can become really nasty really fast. And so one should not wait to weigh in the matter.”

    Like

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