Randomness Is Often Not Random

In statistics, what we often identify as randomness in data is not actually random. Bear in mind, I am not talking about randomly generated numbers or random samples. Instead, I am referring to events about which data has been recorded. We learn of these events when we examine the data. We refer to an event as random when it is not associated with a discernible pattern or cause. Random events, however, almost always have causes. We just don’t know them. Ignorance of cause is not the absence of cause.

Randomness is sometimes used as an excuse for preventable errors. I was poignantly reminded of this a decade or so ago when I became the victim of a so-called random event that occurred while undergoing one of the most despised medical procedures known to humankind: a colonoscopy. In my early fifties at the time, it was my first encounter with this dreaded procedure. After this initial encounter, which I’ll now describe, I hoped that it would be my last.

While the doctor was removing one of five polyps that he discovered during his spelunking adventure into my dark recesses, he inadvertently punctured my colon. Apparently, however, he didn’t know it at the time, so he sent me home with the encouraging news that I was polyp free. Having the contents of one’s colon leak out into other parts of the body isn’t healthy. During the next few days severe abdominal pain developed and I began to suspect that my 5-star rating was not deserved. Once admitted to the emergency room at the same facility where my illness was created, a scan revealed the truth of the colonoscopic transgression. Thus began my one and only overnight stay so far in a hospital.

After sharing a room with a fellow who was drunk out of his mind and wildly expressive, I hope to never repeat the experience. Things were touch and go for a few days as the medical staff pumped me full of antibiotics and hoped that the puncture would seal itself without surgical intervention. Had this not happened, the alternative would have involved removing a section of my colon and being fitted with a stylish bag for collecting solid waste. To make things more frightening than they needed to be, the doctor who provided this prognosis failed to mention that the bag would be temporary, lasting only about two months while my body ridded itself of infection, followed by another surgery to reconnect my plumbing.

In addition to a visit from the doctor whose communication skills and empathy were sorely lacking, I was also visited during my stay by a hospital administrator. She politely explained that punctures during a routine colonoscopy are random events that occur a tiny fraction of the time. According to her, these events should not to be confused with medical error, for they are random in nature, without cause, and therefore without fault. Lying there in pain, I remember thinking, but not expressing, “Bullshit!” Despite the administrator’s assertion of randomness, the source of my illness was not a mystery. It was that pointy little device that the doctor snaked up through my plumbing for the purpose of trimming polyps. Departing from its assigned purpose, the trimmer inadvertently forged a path through the wall of my colon. This event definitely had a cause.

Random events are typically rare, but the cause of something rare is not necessarily unknown and certainly not unknowable. The source of the problem in this case was known, but what was not known was the specific action that initiated the puncture. Several possibilities existed. Perhaps the doctor involuntarily flinched in response to an itch. Perhaps he was momentarily distracted by the charms of his medical assistant. Perhaps his snipper tool got snagged on something and then jerked to life when the obstruction was freed. Perhaps the image conveyed from the scope to the computer screen lost resolution for a moment while the computer processed the latest Windows update. In truth, the doctor might have known why the puncture happened, but if he did, he wasn’t sharing. Regardless, when we have reliable knowledge of several potential causes, we should not ignore an event just because we can’t narrow it down to the specific culprit.

The hospital administrator engaged in another bit of creative wordplay during her brief intervention. Apparently, according to the hospital, and perhaps to medical practice in general, something that happens this rarely doesn’t actually qualify as an error. Rare events, however harmful, are designated as unpreventable and therefore, for that reason, are not errors after all. This is a self-serving bit of semantic nonsense. Whether or not rare errors can be easily prevented, they remain errors.

We shouldn’t use randomness as an excuse for ongoing ignorance and negligence. While it makes no sense to assign blame without first understanding the causes of undesirable events, it also makes no sense to dismiss them as inconsequential and as necessarily beyond the realm of understanding. Think of random events as invitations to deepen our understanding. We needn’t make them a priority for responsive action necessarily, for other problems that are understood might deserve our attention more, but we shouldn’t dismiss them either. Randomness should usually be treated as a temporary label.

2 Comments on “Randomness Is Often Not Random”

By Steven. March 23rd, 2018 at 9:42 am

If it were possible to create a machine that would prevent the causes of colon punctures in colonoscopies, would that mean that all prior episodes of punctures could not come from random events but preventable causes? Therefore, the concept of random causes of punctures never existed in the first place? Sometimes it seems easy to create the term random cause to explain away something that hasn’t been fully investigated.

By Paul. April 3rd, 2018 at 9:10 am

Patient safety as a concept and practice seeks to reduce harm. Such punctures are clearly, harmful, irrespective of whether considered as an error or not, so would typically be reported as an adverse event. If we do not report such, how ever would we seek to reduce the frequency, harmful effects etc? Not forgetting that clinicians also suffer when they cause harm, perhaps through imperfect tools/procedures.

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