Pity Bias

Rocky_Balboa_-_The_Best_of_Rocky_CD_coverWe love underdogs.  Rocky made Sylvester Stallone millions with one great storyline: little guy beats giant.

We hate fat cats.  Our favourite villains have always been rich and powerful.

Regardless of fact, some stories of oppression sound truthier than others.  We want to believe them just in case they’re true. Pity bias moves us.

At the same time, stories of the rich and famous ruining their lives remain popular news.  We love hearing about it.  Part of us enjoys their pain, schadenfreude perhaps.  While we naturally feel pity for underdogs, we just as easily feel no compassion for rich people in rehab.

Public Perception

Except for when doctors get kidnapped in Pakistan, physicians do not engender pity.  Sick patients want to believe in perfect providers.  Historically, physicians played this role as expected of them.

Despite modern redefinitions of le bon docteur, physicians are still labelled the ‘most responsible’ provider.  Lawyers go after doctors, not healthcare teams.

What’s more, physicians work hard.  Driven, from grade school though decades of training, if they survive, doctors’ work ethic turns into above average incomes.

Too Powerful

Stories of physician hegemony always resonate with the public and all levels of system leadership.  Regardless of fact, people believe physicians run healthcare with bureaucrats trying in vain to manage them.  Other providers guarantee a sympathetic audience by telling stories about oppressive doctors.

In large hospitals, departments can have 200 nurses, with dozens of clerks and support staff backed by big, rich unions.  Often 4-6 full time, non-physician managers get hired to lead.  The same department typically hires 1 part-time physician to help with system decisions.  Big, progressive hospitals might devote 40 hours of support divided between a couple physician leaders for large departments, but it’s rare.

Despite being out-numbered by more than 5:1 in funded leadership hours, the ‘doctors have too much power‘ complaint always gains a sympathetic hearing.

Rhetoric of Oppression

Appeal to oppression moves audiences. We love underdogs. It biases decisions before discussion begins.

We need facts.  Transparency.  In a public system, taxpayers should know who holds the reins.  We should post lists of all leadership positions in Medicare including training/degrees held.  Compared with bureaucrats and other providers, only a sprinkling of the 25,000 practicing physicians in Ontario holds leadership spots.  Medicare needs more physicians in leadership; a stronger voice, not less influence.  Doctors bring unique value others cannot deliver.

Compassion, Not Pity or Bias

Physicians do not need or deserve pity.  Most don’t want it.

At the same time, we need to be alert to the pity reflex no matter who’s telling the story.  Of course we need compassion for all complaints regardless of who raises them.  But pity should not bias operations.

Let’s be careful that our love of underdogs doesn’t bias decisions about patient care.

 

Attitude: Good, Bad & Excuses

attitudeOur attitude impacts patients.  Some disagree, but most know work goes easier with a great attitude. Do we agree on what defines a good attitude versus a bad one? Who determines attitude?  What influences it? Can we measure it?

The business literature dwarfs medical writing on attitude.  Here are a few blog posts:

Healthcare literature discusses it mostly as bias or perspective versus inclination or temper:

We know the pain of working with someone foul.  We also know how our own outlook impacts work.  Great attitude makes every situation better.  It calms chaos, turns around patient outcomes and transforms great into excellence.

Good attitude

  • Positive
  • Enthusiastic
  • Realistic
  • Solution-oriented
  • Respectful
  • Forgiving
  • Humble
  • Flexible
  • Industrious
  • Kind
  • Gentle
  • Confident without needing applause
  • Deferent
  • Magnanimous

Toxic attitude

  • Negative
  • Scoffing
  • Sneering
  • Disdainful
  • Ignoring
  • Angry
  • Petulant
  • Derisive
  • Proud
  • Arrogant
  • Suspicious
  • Critical
  • Doubtful

Dozens of things impact attitude: life experience, upbringing, personality, health, social support, faith, …  But attitude remains a choice (see Eat THAT Cookie!: Make Workplace Positivity Pay Off…For Individuals, Teams, and Organizations).

Folks are usually about as happy as they make up their minds to be –  Abraham Lincoln

Instead of choosing our perspective, we tend to let others shape us. Outside sources teach us or model how to think and feel:

  • Media, and others, tell us patients abuse the system for minor complaints.
  • Unions remind us of how bad we have it and rouse fights-rights-marches and victimhood.
  • Associations can model “no one else knows what they are doing”.
  • Colleges portray rigidity, authoritarian proclamations and black and white thinking.
  • Coroners were taught to be circumspect, suspicious and to ‘think dirty’.
  • Professional schools (MD and RN) can promote entitlement, elitism and professional hubris.

Excuses:

“Well, if you had to work as hard as I do, with the bosses I have, you’d have a bad attitude too!”

We come up with great reasons for how we earned our right to be sour.  However, not everyone is vile despite the same ‘great reasons’.  Many people with better reasons to be miserable are not.  Our list of ‘great reason’ are just excuses.

  • I work too hard; no one works as hard as me.
  • Leadership/colleagues/government/culture oppresses me.
  • I have righteous anger over lack of quality.
  • I have a really hard job.
  • My patients are tough/high needs/demanding.
  • My pay is too low; I deserve better.
  • No one listens.
  • I see terrible things/death/pain/suffering.
  • I have to make impossible choices at work.
  • I wrestle with life and death every day; faced with my own mortality.
  • I live with continual anxiety over my own incompetence/imperfection/frailty.
  • My deep concern/compassion for patients makes me angry.
  • I’m frustrated at the lack of perfection/improvement/solutions.

Attitude matters.  It’s a choice.  Bad attitude ruins patient experience even if we deliver great technological outcomes.

If we agree that attitude impacts performance, why don’t we address it?  Can we measure it?  Shouldn’t it be a core element of performance management? We measure and post time based metrics; would we ever measure and post attitude scores?

(photo credit: judiciaryreport.com)

When Viral is bad  

viralI did something that went viral.  It became juicy gossip, a ‘can-you-believe-it’ story.

It was stupid and made people feel bad.  I felt bad. I embarrassed dear friends, hurt old colleagues and gave some enemies fodder to slander.  Very bad indeed.

‘Viral’, not the good kind as in ‘going viral; more like a 36 hr flu that people hate but don’t put much meaning into.  No one died or lost a limb and most have much more interesting things to think about…hopefully.

I learned that

  • Messages get lost unless carried by the audience.
  • Interpretations drown messages.  If people choose misinterpretation,  good luck getting back on point.
  • People hear messages they expect no matter what you say.
  • Delivery becomes the message.
  • Poisoning the well works!

“Those who know do not speak.  Those who speak do not know”

Lao Tzu in Tao Te Ching.

But when does silence support atrocity?  At some point, silence can foster dysfunction. Society improves by speaking truth to power.

  • How can we encourage ‘people of good conscience’ to speak out against oppressive social structures and tyrannical thinking?
  • How can we empower those best able to speak to issues while protecting them from pillory and calumny?
  • Maybe hard questions need, once again, the cloak of anonymity and pseudonyms?

Silver Lining

Neuroplasticity says old dogs can learn new tricks (see The Mind And The Brain: Neuroplasticity and the Power of Mental Force).  We embrace mistakes – eternal possessions – and the humility in forgiveness given and received.  We appreciate relationship and the confidence of those who know us, imperfect frail people.

So, do not lust for going viral…even just a little bit viral.  You might get what you wish for.

“All tyranny needs to gain a foothold is for people of good conscience to remain silent.”

Thomas Jefferson.

PS Please stop reading…nothing more to see here…really boring stuff…

(photocredit: jessicaannmedia.com)