catapult magazine

catapult magazine

Vol 7, Num 2 :: 2008.01.25 — 2008.02.08


Assessing risk with eyes wide open

America loves danger.  America hates risk. 

This is evident by the popularity of Internet videos of people performing Red Bull-fueled aerial stunts that put themselves and others in danger.  We invented extreme sports.  We watch NASCAR for the crashes, football for the helmet popping hits, and Jack Bauer for his adrenaline pumping adventures.  Our national motto is: go big or go home.

On the other hand, “…every public school in the country is required to have six to eight inches of rubber tire fragments, wood chips, or some other cushioning agent under every teeter-totter, swing set, and monkey bars set to cushion every little jump, drop, or fall so that no child will suffer an accidental injury.”  Automobile makers add side impact airbags.  Medical attention depends on liability.  Our national number one priority is to avoid risk at any cost.

This context is the broad setting into which Ben Carson, M.D. writes his latest book, Take the Risk: Learning to Identify, Choose, and Live with Acceptable Risk, one of the premises of which is that we cannot avoid risk.  A second premise is that inaction, seclusion, non-participation is not the answer when facing risk.  Avoiding every risk may avoid physical or emotional injury but we concurrently run the risk of stunting our own (or our children’s) lives.  Opportunity, intimacy and growth inevitably involve a level of risk.

To prove this point, Carson draws on his work as a pediatric neurosurgeon at Johns Hopkins and upon his life growing up as a “black, male, raised in poverty in a ghetto culture on the streets of urban Detroit and Boston, the product of a broken home headed by a poorly educated and very young single mother (married by thirteen, divorced by her mid-twenties when I was eight) who had no professional training or job skills.”

There are, therefore, few people better suited to understand risk.  Carson has both successfully and unsuccessfully separated several pairs of conjoined twins.  And if he spends too many pages recounting the cases he has handled and the process by which he made decisions, it establishes his credibility and when he finally lays out his formula for risk assessment, the reader is already familiarized with how it applies.

His formula for dealing with risks is what he calls the Best/Worst Analysis (B/WA), and it involves answering four questions.

  • What’s the worst that could happen if X?
  • What’s the best that could happen if X?
  • What’s the worst that could happen if not X?
  • What’s the best that could happen if not X?

And while the questions themselves are simple, answering them in a specific situation is not.  In fact, Carson spends the final third of the book serving the dual purpose of fleshing out the B/WA and addressing those issues that he believes could benefit from some risk-rethink.  These include dealing with cancer, speaking openly about his Christian faith, parenting, healthcare and the rising cost of liability insurance, poverty and public policy. 

Carson admits that his risk assessment does not always lead people to the same conclusions, but it does offer a framework for discussion and can help focus the actual risk factors as opposed to perceived risk factors (for example, even though shark attacks happen maybe three times a year on U.S. beaches, while drowning happens thousands of times each year, we are much more afraid of shark attacks.)

Carson’s style is engaging and his content is immediately applicable.  As a personal example, by using his B/WA I scheduled a dentist appointment that had been on indefinite postponement because of my aversion to dentists.  It went like this:

  • What’s the worst thing that could happen if I go to the dentist?  They find a problem and address it.  It is not pleasant for me but it does help.
  • What’s the best thing that could happen if I go to the dentist?  I don’t have any cavities and it is confirmed that I have good teeth and brushing habits.
  • What’s the worst thing that could happen if I don’t go to the dentist?  An undetected problem gets worse until I loose teeth or worse.
  • What’s the best thing that could happen if I don’t go to the dentist?  I beat the odds, and my teeth remain healthy even though most people’s teeth get worse as they get older.

While this risk assessment pales to brain surgery, Carson’s formula is valuable exactly for its ability to give structure to any decision.  After doing this it was clear to me that it was far better to schedule a cleaning than to play the odds that I was probably all right.

In the end, the book is readable, accessible to anyone high school age or older, and immediately applicable to almost any situation.  Because of Caron’s personal and professional background the book is not an attempt to offer easy answers to decision making, instead offering a mental rudder for navigating the risky waters of life in which we often find ourselves.

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