In order to interpret the world, we tell ourselves stories. All day long. About everything. That guy in the grocery store who clipped your heels with his cart? A jerk. The car that cut you off at that intersection? A jerk. A little old lady stopping in the middle of the aisle at the grocery store? Senile.
It is automatic, it takes no effort, and it is completely egocentric. It is a curious fact of the unconscious, effortless, automatic system of the brain that creates our stories that the amount and quality of the data are irrelevant. The guy in the grocery store didn’t notice you because he was worried about losing his job. The car that cut you off contains a parent who is in a hurry to get their child to the pediatrician. The old lady in the store has to stand in the middle of the aisle to see the smaller print on the labels.
Even when we think we have a lot of data, we have either interpreted it incorrectly or can’t pull it from our memory. Similarly, a lot of data does no good if we are unable to think rationally, as happens when we are stressed or scared. And, our data is fogged up by our need for cognitive consonance. (I got all this from Daniel Kahneman’s book, Thinking, Fast and Slow.)
This is where blame comes from.
Blame is a story one person has told himself about the actions of another. The story told is sometimes based on really good data and sometimes not, but remember the amount of data doesn’t really make any difference. For example, Brian Williams, the news anchor, is himself in the news for telling a story that wasn’t true about some reporting he did in Iraq. Now, I wasn’t there, never saw Mr. Williams make the claims he was making, don’t watch his show, and have never met Mr. Williams. The only knowledge I have of him is the funny bits he does for Jon Stewart and on the late night shows. He seems like a nice guy. Therefore, my automatic conclusion upon hearing that he made up his story is to think “Oh, there must be some explanation, he wouldn’t lie.”
My conclusion, which is comfortable and free of cognitive dissonance, is based on almost nothing, but it would take a lot to change my mind. The same sort of thing has been happening with Bill Cosby. It doesn’t seem, to people who don’t know him, like he could ever do the things these women have said he did. It is more comfortable for us to decide the women are lying.
It is very important for patients and doctors to understand each others’ will be drawn, instantly and automatically, on both sides, conclusions that are very hard to alter. The profound importance of first impressions makes this communication even more important. My dermatologist, for example, is a super nice, very competent person. The first time I met her, though, I found her short and dismissive.
“Oh, she’s just not interested, doesn’t care” or some variation of this. Note that this judgment is based on one bit of information, out of which my brain has created a whole story in which I am the victim. Now, my brain happened to be a little worried about some marks I had and, being white with a history of California girl behavior, I needed reassurance. From my point of view, it was important for her to appear to be very interested in me, or at least in my skin. But the doctor has seen a hundred million moles, can tell in a glance if any are worrisome, and can look me over in about 5 minutes and know nothing is wrong. Plus, the doctor, being human, probably had other things going on besides little old me. The problem was that she didn’t know the story I was writing about the encounter, and I didn’t know hers.
This is how lawsuits happen. If it turned out later that one of my moles was, in fact, malignant, I could have considered that first encounter and decided that the doctor had been dismissive, hadn’t listened to my problem, and had ignored or not noticed a potential problem. None of this would be true, and because I am also a doctor, I know more about her story than most patients. I know, for instance, that she is under pressure to see a lot of patients, I know how she was trained, I’m familiar with skin diseases, and I know that mole observation is not a fool-proof way to completely eliminate the possibility of skin cancer in someone like me. Even knowing all that, if I really disliked my encounter with her and was too scared to think clearly, that is the conclusion that could be drawn, and thus the blame can be laid at the feet of someone who was doing the best they could given the particular set of circumstances, and who is not at fault.
Everyone has a story. It is better when we tell it.
Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.
