What Healthcare can Learn from March Madness

Every spring, I look forward to two things: the snow melting, and the NCAA basketball championship tournament. I watch very little TV, but for those few crazy weeks, I am glued to every March Madness game I can fit into my already bleary-eyed schedule. My alma mater is nearly always a contender, but that is only partially the draw. In truth, not unlike millions of other fans, I really watch in the hope of seeing a “Cinderella Story” emerge. There are numerous essays and theories about the psychology behind fandom and the desire to root for an underdog, and also many articles and inspirational movies about come-from-behind underdogs who end up triumphant. Understand what you do well, work with and for your teammates, and together rise to great heights. It was the basis of the book “The Boys in the Boat” about how the 1936 men’s olympic rowing team rose from poverty and adversity to bring home gold in Hitler’s Berlin. This is examined not only in sports, but in education, business, and politics. But what about medicine? Do we in health care really pull for those with challenges, and send a message that if they can believe in themselves, that anything may be possible? Or do we cautiously color our conversations as we feel duty-bound to give accurate and honest accounts of a patient’s health care status, and temper our message with statistics to provide some predictions for the future? Can there be an in-between?

In the recent Texas A&M vs Northern Iowa game, the Texas Aggies were down 12 points with 44 seconds left. Everyone thought it was over- everyone except the Aggies. In a celebrationMarch Madness stunner, they dug deep and found it within themselves to go on a remarkable 14-2 point run and force overtime with just over 1 second left, and eventually win in double overtime. While the sports analysis is complex, the basic message is clear: believe in yourself and never give up.

In a well intentioned effort to want to avoid false hope, I worry that in my own practice, I subconsciously shut down the possibility that my patients can dream. Do I spend enough time suggesting that while there are challenges, that adversities can become motivators, and invite our patients to surprise us, to inspire us, to re-write the story? I am starting to pay attention to the language I use in everyday encounters, and the language I read in the medical and lay literature, and whether it inspires possibilities or implies “game over” when in actuality, the clock is still running.

I hope if we pay attention to it closely enough we can find a way for those of us in medicine to be there on the sidelines and like coaches and teammates, provide guidance, inspire grit, and to the end, cheer madly all the way.

bench

4 thoughts on “What Healthcare can Learn from March Madness

  1. “Do we in health care really pull for those with challenges, and send a message that if they can believe in themselves, that anything may be possible? Or do we cautiously color our conversations as we feel duty-bound to give accurate and honest accounts of a patient’s health care status, and temper our message with statistics to provide some predictions for the future?” Such important and telling questions! How often are we changing the outcome by our framing of the question and our responses? I find it ironic that we physicians and scientists too frequently ignore the biases we bring to the table.

    • Out of curiosity, I Googled “types of bias” and browsed to a convenient list of cognitive biases and their definitions on Wikipedia. A few of these that jumped out to me on the list are directly related to this topic, including:
      -Anchoring. The tendency to rely too heavily, or “anchor”, on one trait or piece of information when making decisions (usually the first piece of information that we acquire on that subject)
      – Attentional bias. The tendency of our perception to be affected by our recurring thoughts.
      – Availability cascade. A self-reinforcing process in which a collective belief gains more and more plausibility through its increasing repetition in public discourse (or “repeat something long enough and it will become true”).
      – Confirmation bias. The tendency to search for, interpret, focus on and remember information in a way that confirms one’s preconceptions.
      – Curse of knowledge. When better-informed people find it extremely difficult to think about problems from the perspective of lesser-informed people.
      – Declinism. The predisposition to view the future (and other things) negatively.
      – Empathy gap. The tendency to underestimate the influence or strength of feelings, in either oneself or others.
      – Framing effect. Drawing different conclusions from the same information, depending on how that information is presented.
      – Selective perception. The tendency for expectations to affect perception.
      – Semmelweis reflex. The tendency to reject new evidence that contradicts a paradigm.

  2. Thanks for the input, Dave. That is an interesting list and it seems like several of those could be explored more in a stand-alone post. I would be interested to see how some of those influence what we currently measure as “patient outcomes” and “value” in health care.

  3. My friend Larry Prusak, who now works for the Gates foundation as a knowledge management expert gave a grand rounds talk at BCH on the difference between knowledge and wisdom. He cited the difference between the fox and the hedgehog. He used examples of how so many experts missed the financial crisis because they were “foxes” steeped in technical or domain expertise. It takes a “hedgehog” — someone with peripheral vision to see with a more open mind or with greater context. Interesting thought

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