Humans, doctors and grad students included, are all prone to rationalization. This can be a good thing. Think about that TV show House, M.D.. The main character is not always right, but he always is totally convinced of his own opinions. If you think about that, it’s pretty remarkable.

When his opinions are refuted by hard evidence, he drops them without remorse. But up to that point, he is sufficiently certain to risk your life on the basis of his conviction. That’s actually a pretty good thing, in the following sense: if he were unwilling to change his opinion after finding new evidence, he would be an extremely dangerous person to have as a physician. By a similar token, if he wanted conclusive proof of a given diagnosis before starting treatment, he would lose patients because they would die before he was certain.

The following formula is reasonable: get the information you can and act decisively on that until better information is available. But it’s only reasonable so long as you keep the information channels open. That’s why Dr. House is a good role model. Despite being a jerk and despite seldom acknowledging that he was wrong, he never persists in a wrong opinion once it’s disproven.

The problem is that we are prone to rationalize the facts based on the diagnosis we had before. Take people who still believe that Saddam Heussein was involved in the September 11 attack. Presented with new evidence, many people will choose to ignore or rationalize around that evidence in order to preserve their old, erroneous conclusion.

And with just a few simple, mental sleights-of-hand, we can preserve that belief. Here’s another fine example: form the NYT, an Iraqi official purchased several million dollars worth of totally useless “electrostatic magnetic ion attraction” detectors that are billed by the manufacturer as being able to detect bombs and ammunition. A few simple tests are sufficient to show that they are capable of no such thing.

Why would someone believe something patently false in light of clear data to the contrary? Before we get all proud about how we are different from them, those other people, I would offer the following words of caution: believing that we are right is seductive to all of us. The only shared standard against which anyone can test his opinions is the physical world and the data that comes from it and that’s not an easy standard to uphold.

Cheers,
Peter

Today’s Big Upshot concerns IQ. I’m not going to do this as well as Malcolm Gladwell who has a great section in his book Outliers: The Story of Success. But, nonetheless, I think it’s worth talking about in the context of a discussion of medical careers. It might be presumed that I.Q. measures intelligence and that intelligence is an important quality in a physician. If intelligence is the brightness of your mental spotlight, then in diagnosing disease it would probably be good to have lots of it.

However, it is at least as important to be concerned with where that spotlight is pointing as it is to have it be very bright. I hope everyone has head the med-school-admissions-anomaly stories (i.e. “this happened to a friend of a friend”). There was this guy who got a 4.0 GPA in college and got a perfect MCAT score and then went to his med school interviews and didn’t get admitted to any of the schools to which he applied. He ended up working at Kaplan, teaching kids how to do well on their MCAT. Weird, huh? If you have not met this guy, you probably will. There’s one in any big school’s pre-med program at any given time. You won’t see much of him, though, because he has a 16 hour a day study schedule

The guy is smart. He has a high I.Q. But the admissions committee knew better than to let him in their institution’s door. They knew that a certain degree if wisdom is prerequisite to be a decent doctor.

Gladwell tells a great tale about a large-scale study of I.Q. in California kids. The researchers followed the fates of these super-smart kids through their lives. Their fates turned out to be remarkable only in their ordinary-ness. These super genius kids did not turn out to be the captains of industry and leaders of tomorrow. In fact, most telling, there were two Nobel prize winners in the original, large sample. They were dropped from the study because their I.Q.s were not high enough.

The New Scientist has an article up this morning that explores come clever ways of testing another aspect of cognitive ability – the analytical, careful reasoning side. What the article really stresses (correctly, in my estimation) is that high I.Q. is only useful if it is fully engaged on the problem at hand. What’s scary is that for lots of questions in life and on tests, people (even really smart people) don’t fully engage their careful reasoning abilities.

So, here’s my point – the Big Upshot, if you will. Tests do help open doors – they validate other achievements, in a way. If grades are grossly disproportionate to SAT or MCAT scores, it might be a red flag. But a standardized test score is only one data point in the minds of any admissions committee, and they’re the only people who care at all. Frankly, a personal connection of any kind trumps any score hands-down. So if you’re pre-med (or on an admissions committee, for that matter) keep that in mind. Being wise enough to really engage with the right questions is at least as important as having the strongest possible abilities which could (potentially) be engaged.

Cheers,
Peter