Joshua deGastyne

Silence, Pride, & Behavioral Engineering

“We cannot change the human condition — but we can change the conditions in which humans work.”  — James Reason

This guy literally wrote the book on Human Error.

Good thing we came up with a new hashtag today.

#TrapTheError

If you can’t prevent them, trap them.


John Nance told us to never expect perfection. As soon as we demand that of ourselves, we become the enemy. We become unable to acknowledge failure… to ask for help… to ask for feedback… to ask for clarification.

And that last one is huge. Even on my best day, I will misunderstand 13.8% of what my colleagues are saying. (They call it the 12.5% rule, but it’s a rounded number just to keep it pretty.)

And that’s a lot. Because physicians talk a lot.

The average doctor only waits 15 seconds to interrupt a patient’s narrative.

The average professor… Continue reading

Incentives, Liars, & Hospitals

My day started in a hot tub with Marcus Aurelius and ended with a man-eating dinosaur. (Don’t ask.)

In between, I learned 3 things:

  • Incentives Form Culture
  • Honesty is the Best Policy
  • No More Hospitals

(Oh, and gondola rides are awesome.)


  1. People talk about the CULTURE of healthcare all the time

“Medical professionals eat their young.” “Those on the outside have a better view of the problems within.” “Don’t risk life and limb [and career] by challenging the knowledge or wisdom of any superior —intern, resident, Big Doc on Campus, or admin.”

Well, I’ve got news.

Incentives form Culture.

It doesn’t just emerge from the ether.

And for the last 51 years, doctors have been financially, socially, and professionally incentivized toward shameful behavior.

  • If I harm the patient and just don’t report it, I get to keep more money
  • If I harm the patient and just don’t report it,… Continue reading
Telluride Experience 2020 Dates

BRECKENRIDGE, CO:
CMF Session One*: 6/8 – 6/11
Bennathan Session Two: 6/15 – 6/18
Session Three: 6/22 – 6/25

WASHINGTON, DC/MD:
Session Four: 7/22 – 7/25

*Session exclusive to the COPIC Medical Foundation Residents.