The problem with surgery, according to Chicago area neurosurgeon George Cybulski*, is rarely the competence of the doctor. One has to demonstrate a high degree of competence to get board certified, after all. Instead, it’s usually decision making under the stress and uncertainty of the operating theater.

In other words, surgeons sometimes apply their brilliant techniques to the wrong problems. As Cybulski notes,

While low back pain may be common, the variability of successful outcome after diagnosis and treatment remains a mystery in many cases and results leading to NOT ONLY significant overuse of resources (imaging, specialist consultation) but also treatment (medication, injections, physical therapy, surgery, etc. etc.).

So despite its common occurrence, low back pain emphasizes the critical need for improved decision making.

In his presentation in June 2025, “Knowing Unknowns: Innovation of Clinical Decision Making Under Conditions of Stress and Uncertainty: Case Studies of Low Back Pain,” Dr. Cybulski applies ideas from a variety of sources, including John Boyd, to address this problem.

I’ve included this presentation on our Articles page as a nice snowmobile** applying Boyd’s concepts to a domain other than conflict.  And you may also learn a little about the anatomy of the lower back (which could come in handy sooner or later).

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*Dr. Cybulski is the author of Can we manage to save healthcare? Lessons from the zombie (coronavirus) apocalypse.

**A snowmobile was Boyd’s metaphor for the process of generating novelty, which he describes in The Strategic Game of ? and ? (1987), slides 6-9. The creation of novelty is also the subject of his presentation, Conceptual Spiral (1992). All of Boyd’s materials are available on our Articles page.