19 April 2009

Operant conditioning

There are quite a few things about human behaviour that have always amazed Dr G. As a child, growing up not long after two world wars, it seemed quite likely that one day Dr Grumble might be called up and have to go to war. In America that happened. Young men were sent to Vietnam. Amazingly they acquiesced and went. Some died. Others were maimed. Dr Grumble has never been much of a one for history but it did always seem to the young Grumble that some wars didn't seem to have much of a point to them. To this day Dr Grumble cannot grasp what the First World War was about. And for that reason it baffles him that young men wanted to volunteer to be killed in their droves in the trenches. Many of them might not have known quite what they were letting themselves in for but war is war. It is not a picnic so really they should all have had some idea of what might happen to them. So many young men died in the Great War that as a young medical student Dr Grumble became very aware of the vast numbers of his elderly women patients who had never married. There had just not been enough men to go round. Sometimes these sad elderly ladies would tell heartbreaking stories about how their fianc├ęs had left to fight in France never to return. Occasionally Dr Grumble would be shown a last letter kept forever in a handbag. For each death at the front several lives were ruined at home. The scale of the misery was enormous.

It's a curious feature of wars that the young die and the old organise the deaths. It's about how human society is structured. Those with knowledge, intelligence and power control those without. Sometimes you hear young doctors bemoan how consultants have sold their training down the river. It is not really true. None of us was asked. But they are right in that the sorry saga was about those with power (not the consultants) controlling those with no power (doctors as a whole). Why they want to do this Dr Grumble will leave you to decide for yourself. It's part of the way societies work. Those with power control those without power. In general those with the power gain and those without lose. It is one of the reasons why some doctors are 'rather anxious' about the elitist charity Common Purpose.

How you control people is an interesting topic about which Dr Grumble has little expertise. But, of course, Dr Grumble does himself control people. He controls clinical staff who work for him. He rarely has any difficulty doing this. His decisions might be wrong but somehow those that work for him are conditioned into knowing that his decision is the one that will stand. This is not done in a climate of terror or fear. In fact if there is something that Dr Grumble has overlooked this will be pointed out to him. And Dr Grumble is quite prepared to change his mind if the evidence requires it. But if there are differing views Dr Grumble's is the one that carries. Everybody accepts this.

Dr Grumble is aware that he also controls his patients. Sometimes he tells them what to do. He may, for example, advise them to stop smoking. This is of limited effectiveness. Telling people directly what to do is not a good way to control them. Sometimes patients have to make a decision. It could be whether to be treated in one of several ways or perhaps not to have any treatment at all. The patient thinks they are making the decision. In reality Dr Grumble wants the patient to make the right decision. They almost always do because of the individualised way Dr Grumble advises them. They feel they have made the decisions themselves but Dr Grumble helped them quite a lot probably without them really knowing. Dr Grumble sees nothing wrong with this. If he goes to the garage with a broken car Dr Grumble is very happy to follow the advice he is given. The only problem at the garage is that they could want to sell the expensive option. That sort of thing can happen in medicine too - especially private medicine.

If you are out to sell things you can use techniques to get people to buy things they don't really want. Dr Grumble knows because he has been a salesman. Dr Grumble, you see, used to sell brushes door to door. He was given half a day's training. The training was very effective. Dr Grumble had the highest sales in the region. The interesting thing was that one day Dr Grumble would sell whisk brooms and the next day it would be carpet sweepers or fire extinguishers. By looking at the sales figures it was apparent that Dr G was selling what he wanted to sell and not what people particularly wanted to buy. He was controlling people. You can easily persuade people to pay for things they don't need or can easily get for nothing. Bottled water is one example.

You may be interested in knowing Grumble's sales tricks. If he was selling, say, a whisk broom he would give the customer a sample broom from his case. As he gave the customer the broom he would ask them to "feel how nice it is." He would point out all its wonderful features and let the customer try it out. Trying it for a short time was a key element. He would never ask the customer if they wanted to buy it. Instead he would ask what colour they would like. The decision to buy was never made. They just decided on the colour and that was that.

The technique for the fire extinguisher was different. Few people have a fire extinguisher because people don't have fires to put out very often if at all. They don't have a problem just as people who don't buy bottled water don't have a problem. The bottled water companies sell water people don't actually need by first sowing the seeds of fear into people by getting them to worry about what might happen if they don't drink their 8 glasses a day or whatever arbitrary figure they think they can persuade people to drink. You create the problem then sell the solution. It is the same sort of technique for fire extinguishers - though probably much more justifiable.

The long and the short of it is that there are all sorts of people out there trying to control others and they use various techniques that we scarcely notice. The relevance of all this to Dr Grumble is that we have entered a period when the medical profession is not in control of its own destiny. Others are setting the agenda and we have become puppets in our own theatre. We are, sadly, just like Skinner's pigeons.

1 comment:

Julie said...

It's not over til it's over, Dr G and it's not over yet. Take heart and keep blogging; people pay more attention to us than you realise..