Empathy in the Age of the EMR

Danielle Ofri
The Lancet

Here is an excerpt:

Keeping the doctor-patient connection from eroding in the age of the EMR is an uphill battle. We all know that the eye contact that Fildes depicts is a critical ingredient for communication and connection, but when the computer screen is so demanding of focus that the patient becomes a distraction, even an impediment—this is hopelessly elusive.

Recently, I was battling the EMR during a visit with a patient who had particularly complicated medical conditions. We hadn’t seen each other in more than a year, so there was much to catch up on. Each time she raised an issue, I turned to the computer to complete the requisite documentation for that concern. In that pause, however, my patient intuited a natural turn of conversation. Thinking that it was now her turn to talk, she would bring up the next thing on her mind. But of course I wasn’t finished with the last thing, so I would say, “Would you mind holding that thought for a second? I just need to finish this one thing…”

I’d turn back to the computer and fall silent to finish documenting. After a polite minute, she would apparently sense that it was again her turn in the conversation and thus begin her next thought. I was torn because I didn’t want to stop her in her tracks, but we’ve been so admonished about the risks inherent in distracted multitasking that I wanted to focus fully on the thought I was entering into the computer. I know it’s rude to cut someone off, but preserving a clinical train of thought is crucial for avoiding medical error.

The info is here.

Deception and self-deception

Peter Schwardmann and Joel van der Weele
Nature Human Behaviour (2019)

Abstract

There is ample evidence that the average person thinks he or she is more skillful, more beautiful and kinder than others and that such overconfidence may result in substantial personal and social costs. To explain the prevalence of overconfidence, social scientists usually point to its affective benefits, such as those stemming from a good self-image or reduced anxiety about an uncertain future. An alternative theory, first advanced by evolutionary biologist Robert Trivers, posits that people self-deceive into higher confidence to more effectively persuade or deceive others. Here we conduct two experiments (combined n = 688) to test this strategic self-deception hypothesis. After performing a cognitively challenging task, half of our subjects are informed that they can earn money if, during a short face-to-face interaction, they convince others of their superior performance. We find that the privately elicited beliefs of the group that was informed of the profitable deception opportunity exhibit significantly more overconfidence than the beliefs of the control group. To test whether higher confidence ultimately pays off, we experimentally manipulate the confidence of the subjects by means of a noisy feedback signal. We find that this exogenous shift in confidence makes subjects more persuasive in subsequent face-to-face interactions. Overconfidence emerges from these results as the product of an adaptive cognitive technology with important social benefits, rather than some deficiency or bias.

From the Discussion section

The results of our experiment demonstrate that the strategic environment matters for cognition about the self. We observe that deception opportunities increase average overconfidence relative to others, and that, under the right circumstances, increased confidence can pay off. Our data thus support the the idea that overconfidence is strategically employed for social gain.

Our results do not allow for decisive statements about the exact cognitive channels underlying such self-deception. While we find some indications that an aversion to lying increases overconfidence, the evidence is underwhelming.13 When it comes to the ability to deceive others, we find that even when we control for the message, confidence leads to higher evaluations in some conditions. This is  consistent with the idea that self-deception improves the deception technology of contestants, possibly by eliminating non-verbal give-away cues.

The research is here. 

Evolutionary Thinking Can Help Companies Foster More Ethical Culture

Brian Gallagher
ethicalsystems.org
Originally published August 20, 2019


Here are two excerpts:

How might human beings be mismatched to the modern business environment?

Many problems of the modern workplace have not been viewed through a mismatch lens, so at this point these are still hypotheses. But let’s take the role of managers, for example. Humans have a strong aversion to dominance, which is a result of our egalitarian nature that served us well in the small-scale societies in which we evolved. One of the biggest causes of job dissatisfaction, people report, is the interaction with their line manager. Many people find this relationship extremely stressful, as it infringes on their sense of autonomy, to be dominated by someone who controls them and gives them orders. Or take the physical work environment that looks nothing like our ancestral environment—our ancestors were always outside, working as they socialized and getting plenty of physical exercise while they hunted and gathered in tight social groups. Now we are forced to spend much of our daytime in tall buildings with small offices surrounded by genetic strangers and no natural scenes to speak of.

(cut)

What can business leaders learn from evolutionary psychology about how to structure relationships between bosses and employees?

One of the most important lessons from our research is that leaders are effective to the extent that they enable their teams to be effective. This sounds obvious, but leadership is really about the team and the followers. Individuals gladly follow leaders who they respect because of their skills and competence, and they have a hard time, by contrast, following a leader who is dominant and threatening. Yet human nature is also such that if you give someone power, they will use it—there is a fundamental leader-follower conflict. To keep managers from following the easy route of threat and dominance, every healthy organization should have mechanisms in place to curtail their power. In small-scale societies, as the anthropological literature makes clear, leaders are kept in check because they can only exercise influence in their domain of expertise, nothing else. What’s more, there should be room to gossip about and ridicule leaders, and leaders should be regularly replaced in order to prevent them building up a power base. Why not have feedback sessions where employees can provide regular inputs in the assessment of their bosses? Why not include workers in hiring board members? Many public and private organizations in Europe are currently experimenting with these power-leveling mechanisms.

The info is here.

Seven Key Misconceptions about Evolutionary Psychology

Laith Al-Shawaf
www.areomagazine.com
Originally published August 20, 2019

Evolutionary approaches to psychology hold the promise of revolutionizing the field and unifying it with the biological sciences. But among both academics and the general public, a few key misconceptions impede its application to psychology and behavior. This essay tackles the most pervasive of these.

Misconception 1: Evolution and Learning Are Conflicting Explanations for Behavior

People often assume that if something is learned, it’s not evolved, and vice versa. This is a misleading way of conceptualizing the issue, for three key reasons.

First, many evolutionary hypotheses are about learning. For example, the claim that humans have an evolved fear of snakes and spiders does not mean that people are born with this fear. Instead, it means that humans are endowed with an evolved learning mechanism that acquires a fear of snakes more easily and readily than other fears. Classic studies in psychology show that monkeys can acquire a fear of snakes through observational learning, and they tend to acquire it more quickly than a similar fear of other objects, such as rabbits or flowers. It is also harder for monkeys to unlearn a fear of snakes than it is to unlearn other fears. As with monkeys, the hypothesis that humans have an evolved fear of snakes does not mean that we are born with this fear. Instead, it means that we learn this fear via an evolved learning mechanism that is biologically prepared to acquire some fears more easily than others.

Second, learning is made possible by evolved mechanisms instantiated in the brain. We are able to learn because we are equipped with neurocognitive mechanisms that enable learning to occur—and these neurocognitive mechanisms were built by evolution. Consider the fact that both children and puppies can learn, but if you try to teach them the same thing—French, say, or game theory—they end up learning different things. Why? Because the dog’s evolved learning mechanisms are different from those of the child. What organisms learn, and how they learn it, depends on the nature of the evolved learning mechanisms housed in their brains.

The info is here.

NACAC Agrees to Change Its Code of Ethics

Scott Jaschik
insidehighered.com
Originally published September 30-, 2019

When the Assembly of the National Association for College Admission Counseling has in years past debated measures to regulate the recruiting of international students or the proper rules for waiting lists and many other issues, debate has been heated. It was anything but heated this year, although the issue before the delegates was arguably more important than any of those.

Delegates voted Saturday -- 211 to 3 -- to strip provisions from the Code of Ethics and Professional Practice that may violate antitrust laws. The provisions are:

• Colleges must not offer incentives exclusive to students applying or admitted under an early decision application plan. Examples of incentives include the promise of special housing, enhanced financial aid packages, and special scholarships for early decision admits. Colleges may, however, disclose how admission rates for early decision differ from those for other admission plans."

• College choices should be informed, well-considered, and free from coercion. Students require a reasonable amount of time to identify their college choices; complete applications for admission, financial aid, and scholarships; and decide which offer of admission to accept. Once students have committed themselves to a college, other colleges must respect that choice and cease recruiting them."

• Colleges will not knowingly recruit or offer enrollment incentives to students who are already enrolled, registered, have declared their intent, or submitted contractual deposits to other institutions. May 1 is the point at which commitments to enroll become final, and colleges must respect that. The recognized exceptions are when students are admitted from a wait list, students initiate inquiries themselves, or cooperation is sought by institutions that provide transfer programs."

• Colleges must not solicit transfer applications from a previous year’s applicant or prospect pool unless the students have themselves initiated a transfer inquiry or the college has verified prior to contacting the students that they are either enrolled at a college that allows transfer recruitment from other colleges or are not currently enrolled in a college."

Before they approved the measure to strip the provisions, the delegates approved (unanimously) rules that would limit discussion, but they didn't need the rules. There was no discussion on stripping the provisions, which most NACAC members learned of only at the beginning of the month. The Justice Department has been investigating NACAC for possible violations of antitrust laws for nearly two years, but the details of that investigation have not been generally known for most of that time. The Justice Department believes that with these rules, colleges are colluding to take away student choices.

The info is here.

The Moral Rot of the MIT Media Lab

Justin Peters
www.slate.com
Originally published September 8, 2019

Here is an excerpt:

I made my final emotional break with the Media Lab in 2016, when its now-disgraced former director Joi Ito announced the launch of its inaugural “Disobedience Award,” which sought to celebrate “responsible, ethical disobedience aimed at challenging the norms, rules, or laws that sustain society’s injustices” and which was “made possible through the generosity of Reid Hoffman, Internet entrepreneur, co-founder and executive chairman of LinkedIn, and most importantly an individual who cares deeply about righting society’s wrongs.” I realized that the things I had once found so exciting about the Media Lab—the architecturally distinct building, the quirky research teams, the robots and the canisters and the exhibits—amounted to a shrewd act of merchandising intended to lure potential donors into cutting ever-larger checks. The lab’s leaders weren’t averse to making the world a better place, just as long as the sponsors got what they wanted in the process.

It is this moral vacuity that has now thrown the Media Lab and MIT into an existential crisis. After the financier Jeffrey Epstein was arrested in July on federal sex-trafficking charges, journalists soon learned that Epstein enjoyed giving money to scientists almost as much as he enjoyed coercing girls into sex. The Media Lab was one beneficiary of Epstein’s largesse. Over the past several years, Ito accepted approximately $1.725 million from Epstein, who was already a convicted felon at the time Ito took charge of the place in 2011; $525,000 was earmarked for the lab, while the rest of the money went to Ito’s private startup investment funds. The New Yorker’s Ronan Farrow further reported on Friday that Epstein helped secure an additional $7.5 million for the Media Lab from other wealthy donors, and that the lab sought to hide the extent of its relationship with Epstein. Ito was Epstein’s contact at the Media Lab. The director even visited Epstein’s private Caribbean island as part of the courtship process.

The info is here.

Connecting the dots on the origins of social knowledge

Arber Tasimi
in press, Perspectives on Psychological Science

Abstract

Understanding what infants know about social life is a growing enterprise. Indeed, one of the most exciting developments within psychological science over the past decade is the view that infants may come equipped with knowledge about “good” and “bad,” and about “us” and “them.” At the heart of this view is a seminal set of studies indicating that infants prefer helpers to hinderers and similar to dissimilar others. What a growing number of researchers now believe is that these preferences may be based on innate (i.e., unlearned) social knowledge. Here I consider how decades of research in developmental psychology can lead to a different way to make sense of this popular body of work. As I make connections between old observations and new theorizing––and between classic findings and contemporary research––I consider how the same preferences that are thought to emanate from innate social knowledge may, instead, reflect social knowledge that infants can rapidly build as they pursue relationships with their caregivers.  I offer this perspective with hopes that it will inspire future work that supports or questions the ideas sketched out here and, by doing so, will broaden an understanding of the origins of social knowledge.

The paper is here.

An Admissions Group Is Scrambling to Delete Parts of Its Ethical Code. That Could Mean Big Changes for Higher Ed.

Grace Elletson
The Chronicle of Higher Education
Originally published August 30, 2019

Here is an excerpt:

A handful of provisions are at issue. One prohibits colleges from offering incentives, like special housing or better financial-aid packages, only to students who use an early-decision application.

Another says colleges can’t recruit or offer enrollment to students who are already enrolled or have submitted deposits to other colleges. Under the NACAC ethics code, May 1 is when commitments by those students are made final, and colleges must respect that deadline.

Another states that colleges cannot solicit transfer applications from a previous applicant or prospect unless that student inquired about transferring.

According to a document sent to NACAC members, the Justice Department believes “that these provisions restrain competition among colleges” and that, if they are removed, thus allowing for more competition, the result “may lower” college costs if colleges can solicit students who have already committed.

If the provisions are removed, the changes will be significant, and turmoil in admissions offices should be expected, said Jon Boeckenstedt, vice provost for enrollment management at Oregon State University.

Removing those parts of the ethical code would allow institutions to recruit students from competitor colleges even after they’ve committed, and to see their own students get poached, he said.

The changes could cause colleges to enter into a precarious dance — keep students committed and simultaneously recruit others, all year long.

Given the uncertainty that the changes would cause for enrollment predictions, especially for smaller, tuition-dependent colleges, higher education’s landscape will be upended, Boeckenstedt said.

The info is here.

The brain, the criminal and the courts

Eryn Brown
knowablemagazine.org
Originally posted August 30, 2019

Here is an excerpt:

It remains to be seen if all this research will yield actionable results. In 2018, Hoffman, who has been a leader in neurolaw research, wrote a paper discussing potential breakthroughs and dividing them into three categories: near term, long term and “never happening.” He predicted that neuroscientists are likely to improve existing tools for chronic pain detection in the near future, and in the next 10 to 50 years he believes they’ll reliably be able to detect memories and lies, and to determine brain maturity.

But brain science will never gain a full understanding of addiction, he suggested, or lead courts to abandon notions of responsibility or free will (a prospect that gives many philosophers and legal scholars pause).

Many realize that no matter how good neuroscientists get at teasing out the links between brain biology and human behavior, applying neuroscientific evidence to the law will always be tricky. One concern is that brain studies ordered after the fact may not shed light on a defendant’s motivations and behavior at the time a crime was committed — which is what matters in court. Another concern is that studies of how an average brain works do not always provide reliable information on how a specific individual’s brain works.

“The most important question is whether the evidence is legally relevant. That is, does it help answer a precise legal question?” says Stephen J. Morse, a scholar of law and psychiatry at the University of Pennsylvania. He is in the camp who believe that neuroscience will never revolutionize the law, because “actions speak louder than images,” and that in a legal setting, “if there is a disjunct between what the neuroscience shows and what the behavior shows, you’ve got to believe the behavior.” He worries about the prospect of “neurohype,” and attorneys who overstate the scientific evidence.

The info is here.