According to a recent report from the Mayo Clinic, 52 percent of physicians report being burned out, and their incidence of PTSD is 15 percent, four times the levels in the regular workforce and three percentage points higher than the levels found in veterans of the wars in Iraq and Afghanistan. These sky-high stress levels inevitably have quantifiable and negative effects on both patient care and physician well-being. The Mayo Clinic found not only that a 1 percent increase in measured burnout led to a 20 to 30 percent decrease in patient satisfaction but, more worryingly still, that 15 percent of all doctors have issues with substance abuse during their careers, and that their rates of depression and suicide are twice the national levels.

Sahlins concluded that in many hunter-gatherer societies, and potentially for most of human history, scarcity was not the organizing feature of human economic life and hence that “the fundamental economic problem,” at least as it was described by classical economics, was not the eternal struggle of our species.

Almost as common is the plausible but erroneous definition of the fundamental problem. Here is one example.

‘Since the end of World War II the American military services have been plagued by their inability to keep highly trained medical people in uniform. There have been dozens of studies and dozens of proposed remedies. However, all of the studies start out with the plausible hypothesis that pay is the problem—whereas the real problem lies in the traditional structure of military medicine. With its emphasis on the general practitioner, it is out of alignment with today’s medical profession, which stresses the specialist. The career ladder in military medicine leads from specialization to medical and hospital administration and away from research and specialized practice. Today’s young, well-trained physicians, therefore, feel that they waste their time and skill in the military service where they either have to work as general practitioners or become chairbound administrators. They want the opportunity to develop the skills and apply the practice of today’s highly scientific, specialized doctor.

So far the military has not faced up to the basic decision. Are the armed services willing to settle for a second-rate medical organization staffed with people who cannot make the grade in the highly scientific, research-oriented, and highly specialized civilian profession of medicine? Or are they willing and able to organize the practice of medicine within the services in ways that differ fundamentally from the organization and structure of a military service? Until the military accepts this as the real decision, its young doctors will keep on leaving as soon as they can.

Or the definition of the problem may be incomplete.

The effective decision-maker, therefore, always assumes initially that the problem is generic.

He always assumes that the event that clamors for his attention is in reality a symptom. He looks for the true problem. He is not content with doctoring the symptom alone.

And if the event is truly unique, the experienced decisionmaker suspects that this heralds a new underlying problem and that what appears as unique will turn out to have been simply the first manifestation of a new generic situation.

The person closest to the problem often has the most accurate information about it. What they tend to lack is a broader perspective. The person working on the line at McDonald’s knows how to fix a recurring problem at their restaurant better than a person merely analyzing some data. What they don’t know is how it fits into the bigger picture. They don’t know whether the problem exists everywhere, or whether the solution wold cause more harm than good if implemented globally, or how to roll the idea out to everyone.