Tuesday, June 28, 2022

Rewards in the Surgery Center

The world needs more applause.

That's a simple truth, and it's a powerful tool not only for making friends and influencing people, but for teaching them too.  From Scientific American comes an article about how positive reinforcement can help surgeons learn:

When Martin Levy, an orthopedic surgeon and Border Collie enthusiast, began training his dogs to navigate agility courses nearly 20 years ago, he never expected to one day use the same techniques to train medical residents.

“Over time, I started to realize that we had better tools for training our dogs than our residents,” says Levy, the residency program director for orthopedic surgery at Montefiore Medical Center in the Bronx. Levy decided to use these tools to help new doctors learn the tricks of the trade.

Levy teamed up with Karen Pryor, the maven of clicker training, to clicker-train young doctors. 

And it works -- at least up to a point.

Why does it work? 

Simple: people are hungry for positive feedback, same as dogs and other animals, and (here's the important part) surgical technique is a neutral trick in that we are not genetically programmed for or against it.  That means that even a moderate reward, like a fairly neutral sign of affirmation, is not opposed by a powerful internal code.

So why not use clickers to get doctors to stop doing certain kinds of behavior, such as treating nurses like shit, or treating patient time as it is of little value? 

Simple:  those common behaviors are internally self-rewarding; they make the doctor feel important and powerful and a weak external neutral cue will not stop a powerful internal drive.      

And what about bill padding, kickbacks, up-coding,  self-referral to doctor-owned clinics (like surgical centers) and selling medically unnecessary services? 

These common doctor behaviors are externally self-rewarding in the form of  bonuses and payments from drug and device companies, direct billing incentives, and revenue sharing from surgical and diagnostic centers.

A weak external neutral cue will not counter the attraction of powerful external rewards.

And right there you know why Karen Pryor could not walk her Border Terrier off-lead in the woods.  A clicker and treats are nothing when the code explodes and the self-reward of the chase courses through the blood of a dog bred for that work.

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