Diagnosis can be a Wicked Problem
I didn't really appreciate this until my third year of residency.
Diagnosis (in business, medicine, and life) can often be a wicked problem.
I didn't really appreciate this until my third year of residency.
Yes, I did understand some of the statistical challenges. No test is perfectly reliable. Even accurate imaging is sometimes more harmful than doing nothing. And laboratory results can lead to contradictory conclusions when you test two different groups of patients.
But I didn’t appreciate that great diagnosis only works when you really understand the problem.
I learned this the hard way. I had assumed that mental health problems are best modeled as brain disorders. Granted, there is a lot of truth behind biological models. Almost every mental illness has a significant genetic component. Brain scans (on average) differ between controls and patients. And all of human experience is filtered through the brain. But in 2026, head imaging and laboratory studies are rarely helpful in the clinic. (Why that may be the case is a discussion for another day.)
In my specialty, the biggest risk to a primarily biological diagnosis is the reflex that occurs afterwards: if this is a biological problem, then it must require a “biological solution." Great clinicians don’t fall into this trap. Recovery is not usually driven by medication, neuromodulation, or even psychotherapy (though these tools can be invaluable!) People usually improve both their symptoms and their biology by changing their relationships, living environment, employment, exercise regimen, diet, or many other different variables. Great treatment digs deep to understand why a specific problem is occurring in a specific person. This might mean testing dozens of hypotheses before finding a solution. A great clinician does not accept simple answers until they are proven to work. That’s not how our system is structured, but it’s the right way to practice medicine.
Business decisions often suffer the same fate. For example, “revenue problems” are a symptom, not a diagnosis. Sales or advertising may be the first place to investigate, but failure can stem from team dynamics, product, positioning, finance, contracts, culture, management, market conditions, and even just dumb luck. Great leaders treat diagnosis as a dynamic process where hypotheses and solutions are tested and not assumed. It takes more time, but it gets better results.
We all crave easy answers. When problems present themselves, it’s hard to keep looking when the “simple” remedy seems to be right in front of you. But the best solutions arise when we approach problems with creativity, patience, and rigorous testing.