Not by a Damsite
A recent article in the Wall Street Journal described the futility of an effort by the Southern California Edison Co. to capture in a computer program the intuitive thought processes of one Thomas Kelly, its resident dam expert. Many hours have been spent trying to make a computer think the way Mr. Kelly does; because Edison is concerned about what might happen if Mr. Kelly should retire or die. The effort has had only mixed success to date, which suggests that that there is more to the value of professional experience and intuition than is generally recognized.
Edison ought not feel badly about its failed effort. Others have had the same experience in trying to put thought processes down on paper. We have not been able to construct a design of how people think, or learn, or remember. It is generally assigned the name "know-how".
The Secretary of the Smithsonian Institution, Robert Adams, hit the nail on the head in the April issue of Smithsonian when he suggested that there is a general yearning to convert knowhow into bits and bytes of information. We have come to believe that we live in an information age and that knowledge is transmissible information. We would like it to be transmissible so that we can make instantaneous, impersonal decisions. However, as Adams pointed out, information--valuable as it may be--is lacking in conceptual structure. When information is combined with experience and insight, it then becomes wisdom.
Efforts in our field to standardize the nonstandard have led to oversimplification and trivialization of a discipline that is neither simple nor trivial, to delays in clinical progress, and to creation of an image of orthodontics as a sort of biologic carpentry. Ramifications of this attitude are seen in:
Further shortcomings have been:
Until recently, orthodontics has been preoccupied with solving mechanical problems. We have become very good at tooth straightening, excellent in materials, and accomplished in mechanics, engineering, and computer science. How-to-do-it has taken precedence over what-to-do and why-to-do-it and when-to-do-it.
If orthodontics is considered to be an unambiguous, mechanical task, it is small wonder that half or more of it is performed by those whose number includes many with no special training for it at all, and a majority with inadequate training. In addition, it is not then extraordinary that there is no more than a 10% differential between the fee charged by a recent graduate and a practitioner with 15 or more years of experience, or that the average orthodontic practice experiences a decline in case starts after 10 years and in income after 15 years.
Diagnosis and treatment monitoring both depend strongly on intuition. Life would be easier if diagnoses could be made on the basis of a set of measurements that could automatically be entered into a computer, if treatment could be laid out in advance with a series of appointment times and appliance adjustments, if we could install one smart, straight wire and watch it do its thing.
The trouble with intuition is that some people have more of it than others. Some can see a whole configuration and others concentrate on its parts. Maybe it is the repetitive, selective use of parts that creates gaps and makes the big picture unrecognizable. How rapidly we can unify knowledge in orthodontics may depend on how long we persist in looking upon it all as separate bits of information. Insight may come from acquiring information that we did not value before, or did not have before, and using it to fill in some of the gaps.