Overlooked in the Name of Expediency
All people, indeed all cells within all people, have features of uniqueness but also features of commonality. That is why biopsies can be diagnostic and sampling of people can reveal what different groups think or how they respond to a drug being tested. Sometimes it’s better to be communally de-identified, at least as long as we understand why. But far more frequently we hold the features that identify us as special in very high value, going to great lengths to become noticed. Some of us broadcast ourselves on social media, at times as sages, other times as trolls, but always as ourselves. Sometimes we believe in ourselves, keeping our identity visible, other times we hide under our avatar as a surrogate identity. Sometimes we define ourselves as numbers, while we add our likes or other emoticons for people to keep score not of us but of the number of different responses.
Perhaps my transition from student to physician many years ago best reflects this tension between being looked at interchangeably among thousands, understanding why, yet resenting the inevitable situation enough to push back. The world’s very first modern university founded in Bologna in 1088 started by attracting careerist who anticipated a prosperous adulthood if they mastered Roman Law. College education leading to freedom, fulfillment, and prosperity remains today. A lot of late teens think becoming a doctor is within their grasp, so many that the required curriculum classes of organic chemistry and biology were conducted in large auditoriums at my school. At least I could see the professors and blackboards. In mega state universities, the premeds watch the professor on the Big Screen. The professor processes us through with exams. These science exams do not lend themselves well to mass computerized scoring so we write in Blue Books, our names on a different page than the answers so the teaching assistant won’t recognize whose minds work best. The grades get tabulated as GPAs, which become our numerical identity. If good enough, we move along to MCATs. No blue books here. We remain people long enough to show our photo ID, then answer questions from five options, scored by a computer which has no emotional content to the score generated.
Still in the running. Applications to a dozen places, each school overwhelmed by the number to doctor wannabes. We are our scores initially, sent letters of regret if too low, interview invitations if sufficient. Only then does somebody begin to read what people who know us express which of our personal features they find compelling. So the school weeds numbers, but ultimately selects people as the medical professions next generation. I found it mostly demeaning, though changed in a moment when the offer of admission arrived. To my credit, the people around me thought I was still talented and diligent, even when beneath the culling cutoff.
As much as I disliked the process, I understood the competitive nature of lots of people wanting a scarce prize, that medical school acceptance. I later to understand the need to classify people and choices. I may be one of 10000 applicants, initially a number, but eventually a doctor. As a clinician every visit I encounter the reverse approach. An ill person sitting in front of me needs my knowledge, always generously offered. But in order to have that knowledge, hundreds or thousands of comparable people who I did not encounter enrolled in studies where their identity was blinded, they were treated not as patients but as subjects of studies, and their outcomes aggregated and tabulated. Their anonymity became my patient’s most important asset.
It’s easy for the clinician or mentor to medical residents to always think about what makes a person unique. This becomes the basis for treatments. It also becomes the basis for writing letters of recommendations for my trainees. Each one will be an asset to his next destination. It remained my obligation to illustrate why. And perhaps my proudest professional achievement was 100% success in the young doctors I recommended securing an appointment. Each one was a promising professional, never a data point. In the other direction, though, I’ve become a research subject myself, now that I am retired from patient care. Both individual and aggregate assessments have their proper place.
While being de-indentified, or colloquially being a number among many, has its communal benefits, there are numerous breaches where having one’s uniqueness disrespected inappropriately creates undesired outcomes, both for the people treated in that brusque a manner and for public outcomes. Some of these have already emerged. Trust in institutions from government to journalism to science has plummeted. Even worse, perhaps, has been not only recognition of those irate from the experience but their exploitation in the form of political appeals, or what the Game Theorists grappling with their iconic Prisoner’s Dilemma would call defection from the Common Good for personal gain. If the public tramples me, I’ll band with somebody on Twitter dedicated to taking that pound of flesh from thems who done me wrong. And those people, not just in America but globally, elect some of them to positions of authority. All to affirm that somebody cares about them when nobody else does.
My pre-med curriculum replaced kindness of the rest of the university experience with expediency. Now approaching fifty years later we seem to have expanded the efficiency at great personal and public sacrifice.