Beware of self selection and self fulfilling prophecy

Because the BMJ is mostly read by clinicians, we should be aware of the risk of self selection.¹ Just as companies can develop an internal culture, whereby only similar personality types are recruited, so the same happens with doctors. We select only those with high academic results, we train them to be problem focused, and, not surprisingly, they tend to select similar people. There is a danger in simply selecting what you already have, as it may not be what you need.

Historically, doctors needed good memories—they will probably continue to do so, but because medical knowledge has outstripped our ability to remember it all, we may do better with someone who is adept at using computer based tools.

We select people who relish solving problems and train them in high stress situations, so we select those who get a buzz out of “winging it.” This may explain why medical practice is slow to adopt care pathways and protocols as “it takes the fun out of medicine.”

Teams often fail because they miss the “finisher” person—we select clinicians with the “shaper” profile, who want to see their solution put into action.² Some of the most dysfunctional teams consist of many shapers, all vying to get their idea through.² Because we need to move to a team based approach to medicine and more flexible roles, perhaps we should review how we select healthcare staff, including whether they need to be “professionals” and whether they should be managers rather than divas.

I admit to somewhat caricaturing clinicians here, but, having run focus groups across a range of stakeholder groups, I have found that clinicians are different in the way they approach matters.