When I was taking my qualifying examinations for my Ph.D. in Psychology, one of my examiners asked me to address what he called the “moon question”: “If human beings are so dumb (according to decision psychology), how did we get to the moon?” The answer, of course, is that despite the predilection in cognitive psychology for inducing and examining error (because error usually provides powerful tests of process models of human behavior), most people are pretty good thinkers most of the time, and some people are very good thinkers most of the time.

Atul Gawande’s excellent 2002 collection Complications: A Surgeon’s Notes on an Imperfect Science struck a responsive chord with medical decision scientists with its insightful examination of medical error. Gawande has now collected 11 new essays in Better: A Surgeon’s Notes on Performance (Metropolitan Books, 2007), which shift the focus to how some physicians come to excel in their craft (in his terms, becoming “positive deviants”). He asks “what does it take to become good at something in which failure is so easy, so effortless?”

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