Self-Diagnosis and Government Contracting

Earlier this week Hadley Wickham, Chief Scientist at RStudio, gave a little talk at Booz Allen. He started out in med school, and one of the things that stuck out from his talk was a comparison between being a consulting statistician and taking a medical history. He tells a similar story in this interview:

One of the things I found most useful from med school was we got trained in how to take a medical history, like how to do an interview. Really, there’s a lot of similarities. When you’re a doctor, someone will come to you and say, “I’ve broken my arm. I need you to put a cast on it.”1 It’s the same thing when you’re a statistician, someone comes to you and says, “I’ve got this problem, I need you to fit a linear model and give me a p-value.” The first task of any consulting appointment is to think about what they actually need, not what they think they want. It’s the same thing in medicine, people self‑diagnose and you’ve got to try and break through that and figure out what they really need.

I think this problem comes up in any consulting or contracting environment. As a consultant, should I:

  1. (a) do what my client is asking me to do, or
  2. (b) figure out why they're asking me to do that, and then figure out what they should want me to do, and then convince them that's what they want to do, and then do that thing?

This is pretty routine, and no surprise to anyone who has worked in consulting. Here's why I'm sharing it though. This is from Megan McArdle's discussion of the CMS Inspector General's report on "How HealthCare.gov Went So, So Wrong."2

The federal government contracting process is insane. [...] A client is a long-term relationship; you want to preserve that. But the federal contracting system specifically discourages these sorts of relationships, because relationships might lead to something unfair happening. (In fact, the report specifically faults CMS for not documenting that one of the people involved in the process had previously worked for a firm that was bidding.) Instead the process tries to use rules and paperwork to substitute for reputation and trust. There’s a reason that private companies do not try to make this substitution, which is that it’s doomed.

Yes, you end up with some self-dealing; people with the authority to spend money on outside vendors dine very well, can count on a nice fruit basket or bottle of liquor at Christmas, and sometimes abuse their power in other less savory ways. But the alternative is worse, because relying entirely on rules kills trust, and trust is what helps you get the best out of your vendors.

Trust is open ended: You do your best for me, I do my best for you. That means that people will go above and beyond when necessary, because they hope you’ll be grateful and reciprocate in the future. Rules, by contrast, are both a floor and a ceiling; people do the minimum, which is also the maximum, because what do they get out of doing more?

Having everything spelled out exactly in contract not only removes trust from the equation, it eliminates the contractor's ability to give you what you need instead of what you originally ask for. It precludes that consultant from exercising their expertise even though that expertise is the very reason they were given a contract in the first place.

Granted, there are some advantages to a consultant only being to do what they are initially asked to do. Unscrupulous contractors can't use that chain of logic in (b) above to convince the client to do a lot of unnecessary things. But if we don't trust government managers enough to resist that convincing, why should we trust them enough to write up the RFPs and judge proposals and oversee the performance of the contracts in the first place?

I've been consulting less than a year, and I've already been exposed to too many government agencies who are the equivalent of a hypochondriac who stays up all night reading WebMD. "Yes, yes, I understand you have a fever and your neck is stiff, but no, you do not have meningitis... no it's not SARS either... or bird flu." "Yes, I understand you head everyone talking about 'The Cloud,' but no, not every process should be run via Amazon Web Services, and no, you don't need GPUs for that, and no no NO, there is no reason to run a bunch of graph algorithms on non-graph data."


  1. During his in-person talk, the patient with the broken-arm-and-cast was instead had a cold and wanted antibiotics, which is a better example since the cold is caused by a virus which will be unaffected by the antibiotics. []
  2. Which incidentally is something I have spilled a lot of ink about previously. []
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