It's Not Hard… but it could be

What if doctors were tenured?

Posted on October 31, 2008. Filed under: Everything you wanted to know about doctors, medical ethics, Personal philosophy, Self-deception |

Reason is the unique path to knowledge. This is the credo of rationalism. Existence as a pure rationalist may be a highly-prized state, but getting there certainly is not “half the fun”. There is a lot of pain involved in recognizing and discarding long-held positions when they do not pass the rationality test. On the lead page of this site, I state that retired urologist has launched a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry. The sticky point in the quest is the concept of knowledge, a goal that can be approached only along the path of reason, yet, as Robin Hanson has pointed out, doctors are “lousy at abstract reasoning”. I have agreed with him profusely in this earlier post, yet I still had a knee-jerk defensive response to it’s reiteration recently on his Overcoming Bias blog. I, and you, are wired that way.

It seems like a quid pro quo thing going on. “If I’m going to go through the pain of admitting my long-practiced deficiencies, those who so readily identify them for me should do likewise,” or something like that. But no. Not going to happen. Actually, can’t happen may be a more appropriate description. I have become convinced that the human brain is hard-wired to ignore certain of one’s own biases, while readily identifying those same biases in others. It’s not a new concept, nor original. Long before neuroscience was a word, the Biblical writer of the gospel of Matthew asked, “Why behold you the mote that is in your brother’s eye, but consider not the beam that is in your own eye?” Why indeed? Perhaps because it’s unavoidable. It bears repeating that those gifted with more intelligence are more likely than those with pedestrian IQ’s to exhibit this defect (skill?). Via intellectual attribution bias, smart people are about nine times more likely to attribute their own position on a given subject to rational reasons than they are the position of others, which they will attribute to emotional reasons, even if that position is the same as theirs (Michael Shermer). Via confirmation bias, smart people tend to seek or interpret evidence favorable to their already existing beliefs, and/or to ignore or reinterpret evidence unfavorable to their beliefs. Hanson considers confirmation bias to be a major contributor to ideological fanaticism, the greatest threat to the world, yet he employs it frequently. He can’t help it: he’s very smart.

In fact, he’s so smart that he has tenure. Now, there’s an interesting concept for a libertarian supporter of free markets, idea futures, and outcome-mediated health care plans! Tenure is, at best, an arbitrary system which may or may not reflect effectiveness, yet which virtually guarantees employment and facilitation. Hanson’s espoused ideas revolve around the establishment of “betting markets on controversial issues, in which the real experts (maybe you), would then be rewarded for their contributions, while clueless pundits would learn to stay away.” (quoted here) Yet his own job doesn’t work that way. One would think that when offered tenure, such a person would have turned it down, on philosophical grounds. Ah, but there is the consideration of responsibility to one’s family. Intellectual attribution bias facilitates just such paradoxical behavior, not just in Hanson, but in humans generally.

So comes the question: what if doctors were tenured? Immediately, it comes to mind that all the things Hanson finds wrong with doctors, and the health care system in general, would be magnified. Doctor arrogance, a frequent topic of Hanson’s concern, would soar, perhaps approaching the level of university professors. Health outcomes, as bemoaned in Hanson’s analysis of the Rand Experiment, would surely, and predictably, worsen, as there would be no correlation between quality of work and job security. If there were a doctor agency similar to the insulating university, one could predict soaring rates of malpractice among tenured doctors, since the consequences would be borne by their institution. On the positive side, doctor-related felonies, such as Hanson documents here, would likely decrease, since commission of a felony would be grounds for revocation of tenure. Doctor supply would surely increase, as would the average age of doctors, since, once tenured, there would be no reason to retire and no pressure to perform effectively. In summation, it seems that university professors would view tenure as an excellent idea for university professors, but a very bad idea for doctors. Personally, I agree with the free markets that Hanson talks about, as opposed to the closed market in which he participates.

I am trying to learn how to think differently (more effectively), since my education and profession actually did not include any courses, or even any experience, in clear thinking, sad to say. I know there is a strong bias about the arrogance of doctors, especially given their rather well-documented failure to make a positive impact on *overall* health care in the USA. I abhor the “doctor arrogance” as well. Any arrogance seen in my posts is (usually) unintentional, and comes not from being a “arrogant doctor”, but from the failing of being an “arrogant person”, a quality that seems widespread among intellectuals. The more I learn about how such “ninja-brained” people think, the less I have to be arrogant about. I’m here to learn.

 

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