Responsibility to Self v Group

Recently I’ve written about the societal tension between The Individual v The Group, when dealing with: (a) limited agricultural and healthcare resources (“The Tragedy of the Commons, Revisited“), (b) environmental stewardship (“Selling Environmental Stewardship“), and (c) medical practice (“The Ongoing Debate for EBM“). If one were to summarize the research and observations that led to those posts, I suppose it could be “Humans in general, and Americans in particular, prefer actions that more directly benefit Self, rather than Group”.

gullivers travels

I’ve also written about the new and expanding trend of employers implementing financial penalties, rather than incentives, for employees failing to pursue healthy behavior (“Where’s the Line Between an Owner’s Right and Individual Liberty?”).

individual v group incentives for weight loss, April 2013

So how shall we interpret the research published this month in Annals of Internal Medicine (Kullgren JT, et al. Individual v Group-Based Financial Incentives for Weight Loss. Ann Intern Med 2013;153:505-514), which showed group-based financial incentive was more powerful than individual incentive at achieving weight loss among obese employees?

In other words, how do we reconcile the preference to reward Self (see first paragraph), with the preference to suffer with Group (see the Annals study)?

running in a groupHeck … that’s easy. Its harder to disappoint teammates than self. We hominids learned hundreds of thousands of years ago that Group is important for safety, food and love, in that order (Maslow’s Hierarchy, anyone?). That’s why civilization and culture developed. The Self was more likely to live and reproduce if he/she remained a part of The Group. Thus, we apply more discretionary effort to team-based pain than individual pain. Or if you prefer, our tolerance for suffering is greater when suffering in Group. Think about your effort when running with mates, rather than alone. In which context do you push yourself harder?

individual fish jumping into fish bowl

We doctors should use this insight into the Human Condition. Not for our patients – Lord No – rather for one another, and for the profession, ultimately benefiting the patient.

Tell me how by leaving a comment.


Leave a Reply

Your email address will not be published. Required fields are marked *