The paradox that leads professionals into temptation

 Andrew Hill in The FT

Before her first ward-round as a medical student, Sunita Sah watched as the consultant leading the group stuffed his pockets with branded pens and notepads from a hospital cart piled with drug company freebies. 

Noting her astonishment, he remarked, “these are the only perks of the job”, and continued to stock up. “I couldn’t help but think: ‘What’s the end-effect of this?’” Sah told me. 

She found part of the answer to that question when she moved from medicine into management consulting and started analysing how every interaction between healthcare companies and doctors had an impact on their prescribing habits. 

Now a professor at Cornell University and an honorary fellow at Cambridge’s Judge Business School, Sah has filled in more gaps with a new study that sheds light on the dark side of professionalism and how to avoid it. 

Her findings are stark and surprising. The greater a manager’s sense of professionalism, the more likely he or she is to accept a gift or bribe. Worse, high-minded professionals may be more susceptible to unconscious bias towards gift-givers, precisely because they are convinced they think they know how to ignore their blandishments. 

“I NEVER turn down something for free that I know isn’t going to kill me!” retorted one manager in response to Sah’s survey. “A free lunch from someone? Go for it! If the guy is fool enough to think his free lunch/dinner/use of cabin, etc, is going to influence me, he doesn’t know me at all! People don’t influence me beyond what I, and I alone, allow!” 

In the study for the Academy of Management Perspectives, Sah equates this “professionalism paradox” to the Dunning-Kruger effect, according to which poor performers lack even the ability to recognise their own hopelessness. 

Sah’s study is based on surveys of managers, but some of the pernicious real-world effects of her paradox are clear. In the extreme case of the opioid epidemic, books such as Empire of Pain and Dopesick (now also a television series) have chronicled the way respected physicians were dragged into the overprescription of painkillers after receiving free gifts and conference invitations from manufacturer Purdue Pharma. 

Yet their ability to self-regulate against conflicts of interest is still many professionals’ first line of defence when watchdogs and legislators start threatening to curb their autonomy with new rules. 

One problem is that we are all professionals now. The term used to be almost the exclusive domain of lawyers, doctors, teachers, accountants, and others who had laboriously acquired specialist knowledge, shown integrity, and deserved an elevated status. Now the same status is loosely claimed by everyone from salespeople to, yes, journalists. The currency has been debased. 

In law, behaving professionally and ethically is “part of your training, it’s part of your identity, it’s what makes you tick — which isn’t necessarily true elsewhere”, David Morley, former senior partner at Allen & Overy, says. But the head of a professional services firm adds that professionalism “can’t be an excuse or a cover story” for a lack of underlying principles. 

These senior leaders are describing the difference between what Sah calls “deep” and “shallow” professionalism. 

Deep professionals should recognise the risk of undue influence and avoid exposing themselves to it in the first place. Her parallel is Odysseus plugging his ears with wax to avoid falling for the sirens’ song, or, more prosaically, managers who decline all gifts, rather than relying on a corporate threshold to protect them. It is “easier for individuals to rationalise and morally disengage the acceptance of [small] gifts”, Sah writes, or even to stop noticing them altogether. 

Deep professionals should embrace continued ethical training, to help embed principles, and embrace an understanding that they may be prone to bribes and influence-seeking. They should also continue to practise their values, just as a concert pianist goes on rehearsing scales. 

Professionalism “isn’t an individual characteristic, or a feeling”, says Sah. Instead, she would like to redefine it as “repeated behavioural practices that demonstrate a deep understanding of the concept”, backed by appropriate rules and codes. In that form, anyone can aspire to deep professionalism. 

“The law as a profession doesn’t give you some status or standing: you have to earn that,” the senior partner of another law firm told me. “We shy away from [the attitude] ‘It’s OK, we’re professionals’.” In fact, professionals who catch themselves saying or thinking anything similar should be on their guard. They may be in the ethical shallows and about to run aground.  

Engineers' Day

 

Whiplash: the myth that funds a £20bn gravy train

Patrick Collinson in The Guardian


Ten years ago I was in a country lane in Leicestershire, indicating to turn right to go into a hotel for a family event. Seconds later my car was a write-off after a young driver careered round the bend, smashing into the rear of my VW Golf. Fortunately I stepped out uninjured. And from that moment I was pestered, again and again, to make a false whiplash claim.

One of the hotel’s guests was first in. “You’ve got to get down the doctors, tell them your neck is really hurting. You’ll easily get £3,000,” said one (I’m summarising here). But my neck, while a little stiff, wasn’t in pain. Others told me I was mad not to apply. But a decade later there is no evidence the crash caused anything other than a mild sprain that lasted a couple of days. And certainly not deserving of the £3,000-£6,000 that is routinely paid out to “victims” of even the mildest of rear-end shunts.

Now one brave consultant neurosurgeon, who has carried out thousands of operations involving neck and back issues, has declared that whiplash is a myth, nothing more than a multibillion-pound gravy train for lawyers, doctors and the victims suffering from “mainly non-existent injuries”.

In a remarkable piece for the Irish Times, Dr Charles Marks, a lecturer at University College Cork, says the medical profession is as guilty as the lawyers. “For 20 years I wrote medical reports which were economical with the truth … the truth being, there was very little wrong with the vast majority of compensation claimants that I saw. I was moving with the herd.” In Ireland, where payouts have reached levels that even the most avaricious ambulance-chasing lawyer here can only dream of, a doctor can earn as much as £3,000 a week in fees after spending 20 minutes with someone involved in a minor car crash, then writing a largely templated report. “It’s a fee of around €350 and you can easily do 10 a week,” Marks says.

Yet whiplash is “almost impossible to prove”, says Dr Marks, with patients self-diagnosing pain that can never be detected using sophisticated imaging techniques such as MRI and bone scans. “All whiplash is minor. Moderate or permanent whiplash is simply non-existent.”

He cites one study of 40 “demolition derby” drivers in the US who had an average of 1,500 collisions each over a couple of years. Compare that to a mild shunt in slow-moving traffic that, somehow, warrants payouts of thousands. Yet just two of the demolition derby drivers reported post-participation neck pain that lasted more than three months.

Dr Marks adds that in Greece and Lithuania, where there is no expectation of financial gain from whiplash, chronic neck pain following a car crash appears simply not to exist.

But one (British) consultant in Ireland is barely sufficient evidence. So I spoke to another whiplash expert, Dr Stuart Matthews, consultant surgeon in major orthopaedic trauma at the Leeds Teaching Hospitals. He sounded even more dismissive than Dr Marks. “There is not a single test that shows abnormality directly attributable to this condition. Diagnoses are purely on the say-so of the person involved. Many orthopaedic surgeons do not believe it is a genuine condition.”

He says early research that provided medical endorsement for whiplash claims has subsequently been rejected. “It’s the emperor’s new clothes. People just go along with it, there is a bandwagon.”

Neck sprain is genuine, he says, but recovery is relatively quick with little evidence of significant physical injury.

Yet the victims of whiplash receive £2bn a year in payouts, a fair chunk of which goes to personal injury lawyers. That’s £20bn over the past decade, paid for out of galloping increases in car insurance premiums. The forthcoming election means that reforms to whiplash payouts, promised in the prison and courts bill, have been shelved.

A new government, of whatever complexion, should reinstate the reforms – and order a major medical review to determine if we have all been conned for years.

The beast that is batting

Jon Hotten in Cricinfo

There was no crueller moment at the end of the Barbados Test than the few seconds that the camera spent on Jonathan Trott. In Bridgetown, the floodlights were on and the twilight was coming, followed by the dark. For Trott something more than a match was over, and it showed in his face. "Sadder still to watch it die, than never to have known it…" as someone once wrote.

A few summers ago I had the chance to talk to a man who had worked closely with England at Loughborough. The conversation got on to Trott and his debut against Australia in the final Ashes Test of 2009. There had been some debate over his selection. There was a last-minute swell of emotion behind a romantic recall for Mark Ramprakash, who was coming towards the end of his great sunburst of runs in the county game. Trott, averaging 97 for the season himself, won the call, and, "as he walked to bat," said the guy I was talking to, "I knew that there was no one that I'd rather see going out there."

Trott made 41 and 119. He had a habit of scoring runs on debut - 245 for Warwickshire 2nds, 134 for the 1st team - and by the summer of 2011, when he made a double-hundred against Sri Lanka in Cardiff, he was established at number three and his average was approaching 67. He was a curio, a gem, a rapidly emerging cult hero. Trott was a batsman whose idiosyncrasies showed. Along with a practice regime that was quickly becoming legendary, his batting had the ritualistic edge that externalised some of the mental processes required to score heavily against the world's best bowlers. Each delivery faced, even those with the most banal outcome - a leave, a defensive push - brought a long routine of walking and scratching and scraping at the crease. Here was a mind that sought to impose order and control on the unpredictability and ever-present danger of batting.

His game was similarly risk-averse, his scoring areas clearly defined and stuck to, his shot selection pragmatic and appropriate. Once set, he sought simply to carry on. His mental landscape appeared entirely different to those of players like Pietersen or Ponting, who needed the challenge to escalate as they batted, and who would escalate it themselves if the bowlers wouldn't, taking risks, provoking conflict that ratcheted up the stakes.

"I play cricket to be effective and I have my things I do to get myself ready for battle. Maybe it can mess with their over rate or whatever, but it's just what I do and I won't be changing it," Trott said in 2009 after the South Africans grew frustrated with the time he was taking between deliveries. 

The mental and physical sides of batting are two halves of a whole. It is a tenuous way to make a living and the stresses and scars can be incremental. They affect everyone differently. When batting defines your professional life, when it becomes a part of who you are, then its vulnerabilities are obvious. Trott's departure from the tour of Australia was never going to be easy to recover from, because the foundations of his batting, the toughness he had built up over a long period, were so savagely undermined, along with his sense of self.

As Trott tried to rebuild with Warwickshire and then the Lions, Alastair Cook also fought for his career. Yet there was always the sense with Cook that he was primarily battling a physical, technical issue, a flaw in his game that he could overcome. It had a psychological element, of course, and doubt must have played its role through his long drought, but it never seemed quite as hurtful as Trott's difficulties. At the same time Stuart Broad was struck a very painful and frightening blow that has put his batting into reverse. Broad is not dependent on the bat for a living, and yet the decline is ominous and clear.

All three are at different points on a spectrum that shows just how implacably hard batting can be. It is a brave occupation, and the brilliance of the very best sometimes obscures how difficult it is, even for those blessed with the greatest of gifts.

Jonathan Trott's difficulties have been associated with the short ball, and that strikes at the very heart of the psychology of batting. It is about many things, but failing courage isn't really one of them. Trott has never been more courageous than when he walked out for the second innings in Barbados, having been bounced out in the first. It was moving because, in all probability, he knew that it would be the last time that he did it. He went anyway, and he exits the battle with honour, taken out on his shield.

My favourite quote in cricket comes from Viv Richards, when he was asked how he'd like to be remembered. "With the bat, I was a soldier…" he said.

That's beautiful and true, and we must salute all of those who understand its meaning.

WHAT Do You Do? Great Responses to this question

1. I'm a proctologist. (Proc·tol·o·gy n. The branch of medicine that deals with the diagnosis and treatment of disorders affecting the colon, rectum, and anus.)


2. "I'm unemployed since leaving prison. But I have applications in to be a bouncer at several whorehouses. Why do you ask?"


3. The Queen: "Oh. I ride around in the last horse-drawn carriage in England—and give tiny hand-waves. But the pay is good."


4.  'Work covered by official secrets act' 


5. 'Model for a contraceptive products company'


6. 'Fiction writer for the police'


7. "It depends what day of the week it is"


8. Not a lot, but its how I do it that counts.