Since coming back to my apartment, I’ve begun to reflect on some of the experiences from this past week of Telluride. Specifically, I’ve thought about what it will take to affect change at my home institution of Georgetown Medical School.
My mind keeps wandering back to a conversation I had with Michelle on Thursday night. We were both rehashing our outcomes from the X Y business negotiation game. I thought that I had a very clever strategy for success. Even though it ultimately failed, I thought that it was sound in concept. My approach was to feign misunderstanding about the rules for the first few rounds and throw the X card 4 times. Then I would act as if I finally grasped the rules and encourage everyone that it is for everyone’s benefit to throw only the Y card. I assumed everyone would see the benefit to this and then we would all throw the Y card after that. Everyone would gain but, because of the 4 X’s I threw at the beginning, I would ultimately have the most money and therefore win the game.
Obviously, it did not work out this way because once I threw the first X nobody trusted me enough to go along with me and so anarchy broke out amongst the group members. We all simply threw X’s for the majority of the game.
In conversing with Michelle I was surprised to learn that she had taken the exact same approach! Predictably, it led to similar bad results. This was a surprise to me because I believed that my strategy arose because of my unique personality rather than some underlying system to the game that prompts a certain behavioral process. How could an extremely altruistic medical student like Michelle have masterminded the same cunning strategy as a trickster like me?
Simple. Because Michelle, like me, was more strongly influenced by the underlying incentives and system created by the game rather than any inherent personality characteristic. I believe that this highlights one of the greatest obstacles to affecting change: the recognition that we are not nearly as unique as we believe.
I think that for us to be successful as medical students we have fostered a strong individualism within ourselves. The medical admissions process incentivizes this individualism by rewarding us a spot in their school over other equally qualified candidates on the basis that we have something unique that we bring to the medical school class.
This is not to say that we aren’t unique. I’ve met some of the most inspiring and intelligent people within my medical school class. My argument is that an overemphasis on this uniqueness or individualism mistakenly leads us to the incorrect conclusion that through sheer power of personality, we will somehow overcome the same problems that have plagued physicians for centuries. We believe that even though we are operating within the exact same system, that by our uniqueness, things will turn out differently for us.
I think this also leads us to abandon advocacy for change when things begin to get difficult. When we begin to fight against the system itself we run into resistance. You don’t get complimented by an administration on your uniqueness or individualism when you are critiquing that same administration. Instead, you get labelled as a troublemaker, a non-team player, or one of the worst ones I’ve encountered; naïve. These labels don’t make you feel nearly as good as the compliments you get when you move through the system without complaint and so we tend to drop our efforts for change.
I believe in order to affect change; we need to be comfortable with the fact that we are not unique and that we are not resistant to the pitfalls faced by our predecessors. In doing this we can become truly unique because we will have the perspective needed to affect true change. We will be able to distance ourselves from the systems in which we operate and decide objectively what is causing the errors within these system and then take steps to fix them. We will certainly encounter resistance but we will be able to handle it because our confidence will no longer be tied to titles that were incorrect to begin with.
If we don’t change this mindset then we are doomed to continue to lose, like I did in the XY game, with an unfounded hope that next time things will turn out differently.