Groupthink in Science

Our colleague Dr. Gary Williams brought to my attention a textbook chapter written by another colleague, Dr. Paul Harris, in a new compilation published by Springer called Groupthink in Science. I was intrigued enough to order a copy of the book, and it did not disappoint. I was so enthusiastic about it that I asked Dr. Williams to write a review of the book and he graciously obliged. We just published it as part of the Winter issue of VDR, and I’d encourage you to have a look online.

Dr. Harris does a superb job with his chapter, as Dr. Williams elaborates, and it’s impossible to review each chapter in detail, but one that I found particularly intriguing is titled “The Physician’s Dilemma: Healthcare and Bureaucracy in the Modern World“, authored by two physicians. On the hunch that some of it may resonate with you, I’m going to quote liberally from the chapter as follows:

  • “Competing incentives between physicians’ way of approaching medicine and the bureaucrats’ approach to healthcare has created tension for both … We propose that ‘burnout’ and related distressed behaviors of physicians are best conceptualized as a symptom of the overall dysfunction within the healthcare system.”
  • “We propose that the key to addressing physician burnout is larger than merely teaching physicians mindfulness strategies of improved coping skills. The goal cannot be to simply train physicians how to endure an increasingly burdensome and nonsensical healthcare system. “
  • “The humanistic component of clinical competence, such as empathy and other interpersonal skills, can be eroded in medical students who are vulnerable to the rigors of medical school … Conventional medical training, although making incremental improvements, is still highly dysfunctional … Too often, this leads to increased isolation or emotional distance.”
  • “Many physicians exhibit compulsive traits, especially what has been called ‘the compulsive triad’ of self-doubt, guilt, and an exaggerated sense of self-importance. Self-doubt often results from having excessively high personal standards … Given these high self-expectations, such physicians often impose equally high standards on others and react strongly if colleagues or staff fail to meet them. There is some evidence that physician training and work is indeed so stressful that many physicians may meet the criteria for a type of chronic stress disorder.”
  • “Physicians now spend roughly two-thirds of their professional time on paperwork – mostly filling out the never-ending fields that are part of the Electronic Medical Records requirements – rather than attending to patients. Remember also, that physicians do not get reimbursed for completing paperwork … Too often these very real underlying issues are ignored or minimized in lieu of labelling the physician as distressed, disruptive or burned-out and advocating for education of the individual instead of reformation of the system.”
  • “The complementary idea to providing business and healthcare administration education to physicians is to teach administrators about clinical medicine … that they are schooled enough in clinical medicine so that they can better understand the complexities of clinical care and better speak to the issue in a common language as their physician counterparts. At a minimum, administrators could better understand how care is organized and delivered on the front lines through intensive clinical shadowing that can help create mutual understanding and perhaps engender respect.”

2 thoughts on “Groupthink in Science

  1. I’m tempted to say, “Duh!” to the main premise, but it’s nice to see recognition in print of the obvious fact that the system–not the physicians–are the problem. However, the idea that administrators can somehow be educated to better understand how they can help is ludicrous. Administrators and doctors do not have the same goals, for the most part. The system is set up to benefit administrators and entities like private equity firms. The welfare of patients is not their primary concern. And doctors are little more than slaves in this cartel.

    • Agreed, Dr Jackman, that the heart of the matter is that physicians sell themselves to the devil when they work as slaves to third party cartels. I wouldn’t say however that educating administrators on what physicians have to deal with in the trenches is ludicrous. The authors quote the board member of an institution who said that one day of shadowing physicians on the floor was more revealing than six years of sitting on the board. We’re all prone to value judgments about the value of work that others do in a system, and inflate our self-worth in the process. Having said that, the chapter does make the point that physicians have to rise up, recapture elements of healthcare that they’ve abdicated, and re-claim control of their own destiny.

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