Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, January 19, 2008

Human Nature

This is my contribution to the Panda-Graham debate about Social Justice, whatever that is. They are never going to be able to come to any agreement because they are beginning with two completely different assumptions about "human nature," a phrase I would argue means even less than "social justice."

Consider the following statement:
Deep down inside, we're really all the same.
Sounds like an innocuous, self-evident statement with which everyone can agree. The problem is that it's wrong. Of course as humans, we all have the same "basic needs" for food, sex, approval and so forth, but the values, morals and experiences we bring to the task of meeting those needs are so different both from person to person as well as from culture to culture that in too many ways to count, we are NOT all fundamentally "the same."

Some people are fundamentally trusting (and therefore trustworthy) and believe, like Anne Frank, that people are really good at heart. Others, perhaps those who failed to master basic trust in infancy, do not think their needs will be met unless they take what they need. Others live in a culture where getting away with whatever you can is the accepted norm; one who works harder than he needs to is a naive patsy.

I think what that statement really means is that deep down inside, we believe everyone else is really like us. Not like we think we are, or what we'd like to be, or what we tell ourselves we are, but how we really really really are, deep in our hearts. (I came to ponder this phenomenon, by the way, when a patient with a drinking problem said to me, "Doesn't everyone like to have three or four beers after work to relax?" Er, no; but it showed me that's what HE wanted.)

Take the following example: walking down the street, you see a wallet fall out of the pocket of a man walking ahead of you. Do you pick it up, run after him and give it back, or do you pick it up and slip it into your own pocket? (Or do you leave it there and just walk by?) How much does the risk of getting caught play into your decision?

Now, instead of answering the question, "What would you do?" in this situation, answer this one: "What do you think most people would do?" I submit that your answer to that second question is what reveals your true character.

What this means is that when Panda says,
We are, most of us, potential freeloaders...
he is really admitting that given the opportunity (and with no risk of being caught) he would take the money and run. Although granted, much of what Panda writes is so over the top it's hard to know how much of it he really means and how much is just the posturing of a blog persona. Still, as one of his commenters puts it:
...the view of life one gleans from the ER is truly confined to the ER....Generalizing to the world from one’s narrow workview in the ER is a dangerous and very strangely skewed view of humanity.
Graham, on the other hand, is young and idealistic; here's his core statement (my term):
I believe that for the most part, [people] do the best they can based on their circumstances.
What this says to me is that Graham does the best he can, based on circumstances of course. There are plenty of people Panda never sees who somehow manage to stay out of the ER; who have no insurance but manage to pay me out of pocket, even though they wait far longer than they should to come in. Panda is a victim of what I call the Denominator Effect (probably the subject of a future post): he doesn't realize how skewed his patient population is, and he doesn't believe that other kinds of patients exist. Oh, he'll acknowledge it intellectually, but deep down inside he doesn't really *believe* it.

Because Panda and Graham, who are so different from one another, each believe that everyone is just like him, they will never -- by definition -- be able to agree. Each is right, but only to his own way of thinking. Human nature, you know.


At Sun Jan 20, 12:26:00 AM, Anonymous Anonymous said...

We also have to look at how much of it comes from deep down and how much of it comes from the surface. When you're in a bad mood, you sometimes feel like the entire world is out to get you. Likewise, when you're skipping down the sidewalk and someone makes a nasty comment, you can't understand why they're so angry on such a beautiful day.

I work in a job where logistics can become tangled up easily. I feel like I'm constantly apologizing to patrons for the confusion and that we're working the problems out to the best of our abilities. After a few months of this job, I found myself explaining away mistakes and frustrations in other people at work as pitfalls in their job. "Maybe he's in the middle of a double shift." "Perhaps there's been a mix-up backstage."

Circumstances and previous actions affect our response to a situation. With the wallet dropped on the street, we might be more likely to give it back if we're in a good mood or if we had recently had an item returned to us. Of course, a crack addict would take the money whereas a boy scout most likely would not.

All in all, if you're right and people think everyone else does what they do, I'd prefer to think everyone will do the right thing. If enough people think that way, then everyone else will think that everyone is good; and people will be all good inside.

At Sun Jan 20, 01:11:00 PM, Anonymous Anonymous said...

Good analysis. Thanks!

At Sun Jan 20, 02:51:00 PM, Anonymous Anonymous said...

You forgot to mention that Panda thinks he knows much more about logic than he actually does. I don't think it's a blog persona. Your assertion that he would, given the opportunity, take the money and run is spot on…as is the bleak observation that he can’t fathom that every person isn’t as egocentric as he is.

You however, are a breath of fresh air in the blogosphere dinosaur!

At Sun Jan 20, 03:14:00 PM, Blogger rlbates said...

Very nice post, Dino.

At Sun Jan 20, 06:36:00 PM, Anonymous Anonymous said...

I've often wondered if Panda would be happier back in his old job since his opinions of patients seem to be, as you say, over the top.

At Sun Jan 20, 10:38:00 PM, Anonymous Anonymous said...

You guys obviously don't really read my blog but just sort of skim it to find something to jerk your knees to. The fact that people will, in general, revert to a freeloader state if given the opportunity is not just an idle opinion of mine or something I pulled out of thin air but a very real phenomenon observed everywhere and perhaps to its greatest extent in the Former Soviet Union as I point out.

My opinions have nothing to do with being a doctor, by the way. My wife and I also managed a housing project many years ago (until my wife found a dead guy in an apartment)and I assure you that the freeloader mindset is not confined to the medical profession. That you get plenty of what you subsidize should be an axiom. If you subsidize dependency in all of its forms you will get as much as you can handle.

Now, you can make policy based on anecdote and a hope the people will "be good" and not abuse or bite the hand that feeds them or you can be a little more reality based. The choice is yours.

As for being egocentric, buddy, almost everybody is except for those rare individuals we call
"Saints." Our society depends on people looking after their own interests.

At Sun Jan 20, 10:54:00 PM, Anonymous Anonymous said...

I am inclined to agree with Panda. Not all perspectives are equally valid. Given his substantially greater life experiences, I give more weight to Panda's opinion on human nature than idealistic young med student Graham's.

At Sun Jan 20, 11:35:00 PM, Blogger tk said...


At Mon Jan 21, 06:36:00 AM, Blogger #1 Dinosaur said...

Anon: I'm no "idealistic young med student" and I have some pretty substantial life experience myself I still find Panda's opinions -- or at least the way they're expressed (and yes, Panda, I read all of your blog, and the comments, and your comments on the comments; not just cherry picking for knee jerking purposes) -- somewhat over the top. I agree he's probably right a great deal of the time, but I still find some of his absolutist flourishes offensive to those who try not to give in to their baser instincts, even with very limited material resources.

You too can make policy based on your "free loader" axiom, but don't forget that you are also subject to confirmation bias by forgetting (or ignoring) those Medicaid patients who use Emergency facilities appropriately.

At Mon Jan 21, 07:22:00 AM, Blogger MedStudentGod (MSG) said...

I've had the wallet issue happen before - and returned it. I've even had it where I held onto a valuable that was forgotten until they returned just to make sure they received it. I like to think a lot of people would do the same, but I also know that there are many who would walk by or take it. I personally know a few med students like Graham and think that we need them, but they're honestly looking at most situations with rose colored glasses and missing the real problem. As far as Panda’s observations…no rose coloring there.

I find both to be interesting reads, but taken with a great deal of understanding that they preach from extreme sides of the spectrum.

At Mon Jan 21, 05:48:00 PM, Anonymous Anonymous said...

Nice analysis, Dino. I think we're each very much influenced by our own environments and personal experiences. We all know that data can be presented in certain ways congruent with our own interests. Panda makes some good arguments and is one of the best spin doctors I know (500 mls in a 1L glass is a glass half empty for Panda - and he's right about the volume measure, but is he right about the message?)

My clinic is full of patients with cerebral palsy, spinal cord injuries, strokes, etc. and skews my perspective towards no-one being a "freeloader." I know this, and try to listen carefully to docs who see other segments of society. But ultimately, I'll be biased to some extent in the way I see things.

In the end the best we can do is read and learn from the perspectives of Panda, Graham, Kevin, Dino... and all the other great medblog voices out there in the hope that we can work together as a profession to "make the best of it" (as Graham says).

At Mon Jan 21, 06:22:00 PM, Blogger Nurse K said...

Part of the problem with the leftist feel-good view Graham takes is that it would be harder to defend if it was generally accepted that the recipients of welfare were, at least to an extent, "freeloading" vs. hard-working people down on their luck who are in need of just a little help. US voters don't rally around giving money to freeloaders, so they all must be re-characterized for the welfare state utopia to work.

Graham wants to do an ER residency...I wonder if the constant stream of verbal abuse, willful unemployment, and bogus complaints will shift his position a bit. Will be interesting to see in the next few years. A clerkship of 6 weeks in med school in the shadow of an ER physician isn't enough to make you jaded.

At Tue Jan 22, 12:07:00 AM, Anonymous Anonymous said...

I really like this post, Dino.

Figuring out that other people don't necessarily think like me with just a few differences in experience was one of those aha moments. But I have to admit, even though I intellectually know this, and can apply it to a lot of my behavior, it is still really hard to approach the world in that way.

It's really depressing to find out that the way some people live in this world really sucks. I'm not just talking about their life circumstances, but their interpretation of their experience. You could fix their 'place' in the world all you wanted, and they'd still be miserable. Then again, we have the opposite, those who find a way to be happy anywhere.

At Tue Jan 22, 06:29:00 AM, Blogger #1 Dinosaur said...

Bingo, Ami; You hit the nail *right* on the head!

At Tue Jan 22, 08:21:00 PM, Anonymous Anonymous said...

My reading of Panda's blog has given me the impression that he would prefer to spend his working time with persons who are either highly skilled and/or highly educated. Which his prior career as an engineer provided for quite nicely. I suspect deep down, that if someone today gave him enough money to pay off his debts taken on while training to be a doctor, he would gladly accept the handout, turn his back on a medical career, and return to engineering.

Given his adverse reaction to those different from himself, I've got to wonder why he chose to work in an ER. It's a place that is overrun with difficult, challenging scenarios involving people from all walks of life. Then again, I can see the appeal of ER work for Panda: he does not have to provide care on a long term basis to anyone, most of the work is episodic in nature, and there is periodically a great of excitement when someone is gravely ill or injured. His dealings with patients, no matter how much he may dislike some of them, are brief, compared to doctors who practice in offices.

This is not to say that I think Panda is not capable of making sound medical judgments. From what I can glean from his blog, he appears to be quite capable in his ER work. It's simply that he gets little satisfaction from what he does, even when he's helped someone recover from an illness or injury. In fact, I don't recall him writing about a positive experience with a patient.

Then again, perhaps someone will point me to a post on his blog in which he did write about a positive time with a patient.

At Wed Jan 23, 11:56:00 AM, Anonymous Anonymous said...

The truth is is that no one would read Panda's blog if he didn't use sacasm, hyperbole, and wit in his writings. The problem is these sometimes come off as negativity and discontent. I find Graham's writings to be stereotyped and dull responses that I can hear by going to my med school AMSA meeting or just talking to one of the 100s of naive premeds at SDN.

Panda gives an interesting take on REAL events that happen to him. And for everyone who doesn't realize it he is using showmanship that sometimes comes across as negativity and glass half empty. I pose this challenge to you: rewrite Panda's articles with same basic message in a way that appears positive, upbeat, and compassionate. If you do I bet you it wouldn't be all that interesting.

At Wed Jan 23, 01:26:00 PM, Blogger The Medicine Man said...

I'm actually a bit surprised how many people like this post. Attributing these writers' views to their intrinsic characters avoids addressing the strength of their arguments and comes very close to psychobabble. Such an approach renders them both children, victims of their make-up and unable to develop opinions that can stand up under their own weight.

This strikes me as disrespectful of EACH of their viewpoints.


At Fri Jan 25, 04:19:00 PM, Anonymous Anonymous said...

There is another dimension you are forgetting--insight. We think others are like we *think* we are. But is our self-assessment realistic? The person who sees only the negative is cynical, perhaps even depressed. But who has looked into their own soul and seen only goodness? I submit, only those who don't look very deeply.

The task of those of us who want to make the world better is to nurture the good and discourage the evil in ourselves and others. In that respect Panda is right on in his intentions. Who wants to encourage people to be lazy? No one, really.

At Sun Jan 27, 01:01:00 PM, Blogger DDx:dx said...

I really see this as the divide of teaching responsibility. We want people to be responsible. Will they get there with "help" (liberal/social programs/support) or expectations and consequences(kick in the butt/hard times/opportunity)?
I argue for the middle path.
Let me paraphrase Fratarolli( Healing the soul in the age of the brain).
He was struggling to teach his young son to ride a bike. He ran along behind holding the seat. The kid kept looking back, frightened, just couldn't get the knack.
Then dad comes home from the shrink office and sees his kid riding up and down the block. After his dad chagrin he asks his son how he learned. Son says he asked Billy, neighbor who could ride already, how. Billy says," You just have to fall down alot."
Panda wants to let more people fall down.
Graham is holding the seat....
I think learning occurs with both approaches. Some need more of one, some another. Our job, as healers, teachers is to know the balance.

Now, the hyperbole of Panda has driven me off.


Post a Comment

<< Home