From Maryam Kouchaki and Isaac H. Smith’s “Building an Ethical Career”

So how can you ensure that from day to day and decade to decade you will do the right thing in your professional life?

The first step requires shifting to a mindset we term moral humility—the recognition that we all have the capacity to transgress if we’re not vigilant. Moral humility pushes people to admit that temptations, rationalizations, and situations can lead even the best of us to misbehave, and it encourages them to think of ethics as not only avoiding the bad but also pursuing the good. It helps them see this sort of character development as a lifelong pursuit.

We all have a personal opportunity to make being good an active choice. I’ve always loved the view that being an ethical person isn’t a character trait but an endless series of (often challenging) conscious choices. We see so many examples of people who are good in some capacities but not others precisely because it’s sometimes easier and sometimes harder to make what are—at least in hindsight—clearly right or wrong choices.

Preparing for ethical challenges is important, because people are often well aware of what they should do when thinking about the future but tend to focus on what they want to do in the present. This tendency to overestimate the virtuousness of our future selves is part of what Ann Tenbrunsel of Notre Dame and colleagues call the ethical mirage.

Counteracting this bias begins with understanding your personal strengths and weaknesses. What are your values? When are you most likely to violate them? In his book The Road to Character, David Brooks distinguishes between résumé virtues (skills, abilities, and accomplishments that you can put on your résumé, such as “increased ROI by 10% on a multimillion-dollar project”) and eulogy virtues (things people praise you for after you’ve died, such as being a loyal friend, kind, and a hard worker). Although the two categories may overlap, résumé virtues often relate to what you’ve done for yourself, whereas eulogy virtues relate to the person you are and what you’ve done for others—that is, your character.

I often wonder how many of my goals or projects fall firmly into the wrong camp.

Many factors go into choosing a job—but in general people tend to overemphasize traditional metrics such as compensation and promotion opportunities and underemphasize the importance of the right moral fit. Our work and that of others has shown that ethical stress is a strong predictor of employee fatigue, decreased job satisfaction, lower motivation, and increased turnover.

And this brings us to a nice medical dovetail. How many physician jobs now exist within a bureaucratic or corporate structure that is counter to how we feel a physician should be forced to practice medicine and that is counter to the best interests of both the practitioner and patient? How did we ever let a 15-minute appointment become normal? For anything?

And lastly, helpful litmus tests: publicity, generalizability, and mirror:

Three tests can help you avoid self-deceptive rationalizations. (1) The publicity test. Would you be comfortable having this choice, and your reasoning behind it, published on the front page of the local newspaper? (2) The generalizability test. Would you be comfortable having your decision serve as a precedent for all people facing a similar situation? (3) The mirror test. Would you like the person you saw in the mirror after making this decision—is that the person you truly want to be?

These are important things to consider before any big decision. Yes, they’re basically all the golden rule—but how often do you forget to use it?

The political theorist Hannah Arendt once wrote that the most successful totalitarian leaders of the 20th century instilled in their followers “a mixture of gullibility and cynicism.” When they were lied to, they chose to believe it. When a lie was debunked, they claimed they’d known all along—and would then “admire the leaders for their superior tactical cleverness.” Over time, Arendt wrote, the onslaught of propaganda conditioned people to “believe everything and nothing, think that everything was possible and that nothing was true.”

– McKay Coppins, writing about political disinformation for The Atlantic.

F. Scott Fitzgerald is often quoted as saying that “the test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

What microtargeting of vulnerable people has created is the opposite: minds that filter all ideas, opposing or not, through a distortion filter that makes them unable to think critically on anything. Facts don’t matter, because everything is just a predictable reaction based on a fundamental premise, world-view, or political exigency.

That article is extremely depressing. But if you’ve ever wondered what would happen if/when the internet became so drowned out by bots and misinformation noise that it becomes useless, you’d enjoy Fall by Neal Stephenson.

Jonathan Haidt, author of The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure, in an interview for Next Big Ideal Club:

Back in the 1990s, the Cold War was over, the fear of nuclear war was gone, the [United States] ran a surplus, the crime rate plummeted—and the music was pretty good, too. The risks kids were at from diseases, car accidents, and crime were all plummeting. It was the safest time ever.

But because of changes in the media environment, we were divorced from reality—we got a steady diet of stories about childhood abductions. Almost nobody gets abducted in the United States—there are about 100 true kidnappings a year in a country of 350 million people. It almost never happens, but each time it happens, especially if it happens to a middle-class white kid, there’s constant coverage.

…

Throughout history, there have been innovations that link us closer together, and whenever that happens, there are all kinds of unforeseen effects. Take the automobile—people can move around, so it changes sex life, and dating, and marriage. The automobile, the telephone, the airplane—all of these things have effects on society, and it takes decades for that to work out. But with social media, we’ve never had something come in so fast that was so transformative in changing social relationships.

And the problem is not the internet, and it’s not screen time. Research that I’m collecting shows that it’s not time spent watching Netflix, and it’s not even time on the computer. It’s specifically social media that has pushed us over the edge, and I think it is a major cause of the rise of depression and anxiety, [especially] for girls.

Had Facebook, Instagram, and Twitter never been invented, I do not think our politics would have blown up. I do not think Donald Trump would be president. I do not think Brexit would have happened. I do not think that our democracy would be as imperiled as it is. Of course, Facebook and Twitter do a lot of good things, too, but the downside is so severe that I’m beginning to worry that social media is incompatible with a functioning democracy.

I wonder.

Social media is seductive even though it’s most effective as a way to literally waste time. But I’m older than the generation Haidt is worried about. And even to me—as someone who has written exclusively on their own platform for over a decade and grew up with just AOL instant messenger—it’s amazing how easy is it to fall prey to the endless feed.

Management consultants insist that meritocracy required the restructuring that they encouraged—that, as Kiechel put it dryly, “we are not all in this together; some pigs are smarter than other pigs and deserve more money.” Consultants seek, in this way, to legitimate both the job cuts and the explosion of elite pay. Properly understood, the corporate reorganizations were, then, not merely technocratic but ideological. Rather than simply improving management, to make American corporations lean and fit, they fostered hierarchy, making management, in David Gordon’s memorable phrase, “fat and mean.”

From “How McKinsey Destroyed the Middle Class” by Daniel Markovits, subtitled “Technocratic management, no matter how brilliant, cannot unwind structural inequalities.”

I do enjoy his inclusion of Kiechel’s apt Animal Farm reference.

A couple of interesting reads from Matt Stoller’s BIG newsletter about private equity. Given the current flood of PE group buyouts and market consolidation in healthcare, it’s not hard to draw parallels between radiology practices ten years from now and what happened to Toys R Us in 2018 or to identify the obvious issues that arise over the long term when the frontline and c-suite have zero overlap.

From “Why Private Equity Should Not Exist”

The goal in PE isn’t to create or to make a company more efficient, it is to find legal loopholes that allow the organizers of the fund to maximize their return and shift the risk to someone else, as quickly as possible.

From “WeWork and Counterfeit Capitalism”

Across the West, the basic problem of a corrupted productive process is becoming a quiet crisis. The reason is simple. The people that do the work in organizations are increasingly excluded from the decision-making about the work. That is why Boeing is losing its ability to build planes, why we can’t build infrastructure, and why New York City is on the verge of disaster.

From this NYTimes’ interview with Malcolm Gladwell about his new book, Talking to Strangers:

“That happens in these divided times — your professional identity becomes your identity,” Mr. Gladwell said.

“On every level,” he added, “I feel like there is this weird disconnect between the way the world is presented to us in the media and the way it really is. The goal is simply to give people an opportunity to reflect on things they otherwise wouldn’t reflect on. What they do next is out of my control.”

When people ask me about AI and radiology or automation in general, I tend to take an Amara’s Law view: We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.

But the short term overhype is our best chance to make thoughtful structural changes that will allow for desirable future outcomes. A lot of mental health and structural economic problems are tied up in Gladwell’s first line:

If your professional identity is your identity, what happens when you or your profession need to change? If the individuals you meet are just proxies for the job they do or the service they provide, then they aren’t people to you.

Rutger Bregman, author of Utopia for Realists and the Dutch historian from the viral video calling out billionaires at Davos (“taxes taxes taxes, all the rest is bullshit in my opinion”), talking to Ezra Klein in Vox:

We should never underestimate capitalism’s extraordinary ability to come up with new bullshit jobs.
…
We could theoretically live in some kind of dystopia where we’re all just pretending to work and sending emails and writing unnecessary reports, and the robots are doing all the real, valuable work.
…
Now, who are these people? They often have wonderful LinkedIn profiles, went to Ivy League universities, have excellent salaries. They work in marketing, finance, etc. Still, at the end of the day, if you give them a beer or two, they’ll admit that their job is perfectly useless. If we actually rewarded people for the value of the work they do, I think that many bankers would earn a negative salary while many nurses and teachers will be millionaires.

And then dovetailing healthcare into this pretty wide-ranging discussion on automation, universal basic income, and the depressing way we value/pay people who are essentially a drain on the system (not through welfare but through wealth extraction):

Economists talk about how it’s some kind of problem that government is not efficient enough compared to the private sector, but I think that’s actually the point. The point of the future is that we can have a huge amount of inefficiency because that’s what makes life meaningful. Good care is inefficient. You actually have to talk some to someone to have the meaningful relationship. If you want to make health care more efficient, you usually destroy it.

What if healthcare didn’t have to be an industry anymore? It’s really a mind-blasting thought.

…it’s because we have two adorable kids now.

(Photo by @whatlbsees)