#89: Three Things that got me thinking
✍🏻Oscar Wilde + 😏 snarky fun + ✉️accountability
Hola, thoughtful reader!
Here are three things that made me think about intrinsic motivation in the past days:
Dorian Gray
A Guardian column
The real reasons behind medical complaints
Before I go into them, a kind reminder that I published an enlightening Q&A with health psychologist Rory O’Connor for World Suicide Prevention Day, on 10 September. I hope it reaches as many people as possible.
Onto this week’s Things:
1. Bad influence
I’m re-reading The Picture of Dorian Gray (though I think I didn’t finish it the first time around). Here’s what Lord Henry tells Gray shortly after meeting him in Chapter 2:
“There is no such thing as a good influence, Mr. Gray. All influence is immoral – immoral from the scientific point of view.”
“Why?”
“Because to influence a person is to give him one's own soul. He does not think his natural thoughts, or burn with his natural passions. His virtues are not real to him. His sins, if there are such things as sins, are borrowed. He becomes an echo of someone else's music, an actor of a part that has not been written for him. The aim of life is self-development. To realize one's nature perfectly—that is what each of us is here for. People are afraid of themselves, nowadays. They have forgotten the highest of all duties, the duty that one owes to one's self.”
2. Spot-on
I enjoyed this snarky Guardian column by Emma Beddington, ridiculing silly / toxic lists of things you must have done by X years old:
The sense you aren’t where you should be, and that others are, is a surefire thief of joy, and we shouldn’t let blokes who overuse fire emojis steal our joy.
and
People, you discover, do awe-inspiring things at every age: there’s an 86-year-old water polo player in this week’s New York Times. But more importantly, they do the things they, not anyone else, wants: what fulfils them and what they enjoy.
3. Why patients complain
I’ve been finding Twitter even more tiresome and toxic than usual these days, but did come across an interesting thread by Marie Bismark, a professor of public health law at the University of Melbourne, Australia, who’s been studying patient complaints for 20 years.
In a 2006 paper, using case studies from New Zealand compensation claims and complaint files, Bismarck and her co-author listed the reasons why patients (or their families) take legal action after a medical injury: “money is only one of them”.
These motives, which all can be considered to represent a demand for some form of “accountability,” generally fit into four themes:
restoration, including financial compensation or some other intervention to “make the patient whole again”;
correction, such as a system change or competence review to protect future patients;
communication, which may include an explanation, expression of responsibility, or apology; and
sanction, including professional discipline or some other form of punitive action.
In New Zealand, the paper explains, injured patients are entitled to government-funded, no-fault compensation through the Accident Compensation Corporation— without claiming negligence or error. Whereas in a tort-based system (like in the United States), “where money is effectively the only remedy available to injured patients,” plaintiffs end up using the courts to demand damages that may mask their other motives.
(The link in the tweet below is broken, but you can download the paper as a PDF here.)
This reminded me of the “McDonald’s hot coffee case” episode of the (funny, smart) podcast You’re Wrong About. Remember that drive-through coffee burn story? It was reported in the 1990s as the epitome of frivolous lawsuits in the US. In the episode, Michael Hobbes explains in detail how this case is not a story of "jackpot justice", but a story of government outsourcing regulatory functions1 to the courts (and insurance claims).
What we want as a society is we want victims to be made whole again. And we want corporations to behave differently. I want McDonald's to not serve its coffee that hot again and I want Stella2 to be fine. […] We've linked these two things, but you can also imagine a situation where just like the government steps in and does both of those things separately. We don’t need Stella and McDonald's to have a fight with each other.
In contrast, Bismarck writes:
By separating financial compensation from other forms of accountability, the New Zealand system is able to distinguish effectively between injured patients’ tangible and intangible needs, and respond effectively to patients’ desire for sanction, restoration, correction, and communication.
Many people who would rather not go into long, expensive lawsuits end up suing because that’s the only way to cover gigantic medical bills, for instance. This quote from You’re Wrong About refers to corporate liability:
All of this goes back to what was called the ‘tort revolution’. Basically from the end of World War II until the 1970s is this time of very ambitious, progressive change in America. We get the national traffic and motor vehicle safety act of 1966. We got the consumer product safety act in 1972.
The Warren court starts passing a bunch of very arcane and weird procedural things that make it much easier to sue companies. […] America ended up making this pact that this was how we were going to regulate corporations. In a lot of other developed countries they have regulators, they have very powerful regulators that do inspections. They can, by law, force companies to change their practices. They can give payouts to people that are damaged by corporations. None of that really took in America. None of our regulatory agencies ever had that much power. So we basically decided we're going to do this by lawsuits.
Stella Liebeck, the 79-year-old victim, was severely burnt and required skin grafts.