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Epi Wit & Wisdom Letters
On the Proper Role for
an Epidemiologist—Another View
In the October 1982 Epi
Monitor, Dr. Oscar Sussman wrote a thought provoking
piece on the epidemiologist’s role during outbreaks. While I was not
directly involved with the outbreak, Dr. Sussman described, I was the
epidemiologist who investigated the subsequent two outbreaks. Thus, I
have direct knowledge of the institution and problems involved.
An epidemiologist is a
consultant often invited to investigate a specific problem. As Dr.
Sussman suggests, the epidemiologist should not be expected to
function with blinders on. For example, suppose the epidemiologist
studying an outbreak witnessed a hospital staff member choking a
patient. What should be done? Nobody would argue with Dr. Sussman that
under these circumstances “an epidemiologist should seek to change
conditions then and there.” However, in less dramatic and obvious
circumstances, the impetus for change should be directed to those
officials who bear the responsibility and line authority to rectify
problems. “Raising hell;” “reading the riot act;” and “lowering the
boom” are generally poor techniques of communication. Often such an
approach is polarizing.
If an adversary role is
created from the consultant being perceived as overly aggressive, the
main points of the consultant’s thesis are lost in the ensuing battle
of personalities. Issues become obscured as each party seeks to be
“right.” Rather, the consultant should seek to convince through gentle
persuasion, logical argument, and demonstration of strong evidence in
support of the hypothesis and recommendations. The choice of
intervention strategy should be geared to the urgency of the
situation. It is well to bear in mind, however, that the carrot often
works better than the stick.
Two Camps
Dr. Sussman implies that
epidemiologists dichotomize into two camps: the uninvolved attack rate
calculators (“most CDC’ers”) and the “hell raisers.” I suggest that we
are distributed along a continuous spectrum and the two camps he
describes lie outside two standard deviations from the mean.
Clustering about the mean are those epidemiologists whose findings are
supported by data and whose communications are tactful, objective, and
still forceful.
Dr. Sussman suggests that
epidemiologists are protected from not “being invited in” to
investigate because where else would managers take their epidemic
business? The answer, I fear, is nowhere. Most epidemiologists are
aware of past outbreaks that were allowed to rage on because of
ignorance, indifference, malfeasance, cover-ups and publicity
concerns. Let us not add fear of adversary epidemiologists to the
litany of reasons that managers choose not to investigate problems.
While the adversary “hell
raising” approach may occasionally work in the short term (it did not
in Dr. Sussman’s case), it may lessen the likelihood that future
problems (and opportunities to learn from them) will be investigated.
I am not suggesting that an epidemiologist should refrain from
forcefully stating the case. I do suggest that this be done
dispassionately, diplomatically, and in a manner that allows
management to be a partner and not an adversary. Farr’s “arguing
fearlessly for recommended changes regardless of what vested interests
may be involved” does not mean that the epidemiologist must shout to
be heard.
Jeffrey J. Sacks, MD,
MPH
Published November
1982
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