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Cognition

Don't Ask, Don't Know

Ignorance is no excuse. But sometimes it's understandable.

Several months ago, I wrote a post on the psychology of the lie that spins out of control. At the time, the news of the day focused on a politician who had exaggerated his military service (or, at the very least, failed to correct others' exaggerations) and a young man who had successfully forged his way into Harvard. In the post, I explored how these cases of longstanding fraud often evolve slowly over time and are rationalized through processes of self-delusion.

Well, it's also interesting to consider from a psychological perspective how these ruses and exaggerations are perceived by the rest of us. Because without a gullible audience, these stories come to a screeching halt. Or they never get off the figurative ground to begin with. As many a philosopher has pondered, if a fraud case falls in a forest with no one around to be duped by it, does it make a sound?

Consider the recent unmasking of William Hamman, a cardiologist and airline pilot who ran seminars for the American Medical Association and various health systems entitled: "This is Your Captain Speaking: What can we learn about patient safety from the airlines?"

Ah, yes... I don't know about you, but every time I fly coach, I find myself thinking, gee, I wish the same folks running this show were also in charge of my kids' physical well-being and life expectancy. I wonder what type of voucher they'd offer when you get bumped from your scheduled bypass surgery due to overbooking?

My own reservations aside, Hamman apparently was a popular speaker. He advocated the expansion of simulation training into medical settings; in his workshops he emphasized the importance of teamwork and communication under stressful conditions. The only problem was that Hamman wasn't actually a cardiologist. For that matter, he wasn't even a doctor: William Hamman doesn't have a medical degree.

How, you might ask, does someone with no medical background become a well-known medical educator? Well, the real question is how he got his very first speaking gig. Did he know someone at a medical center? Did he happen into a conversation with a physician who just assumed Hamman was an expert?

Because the easier question to answer is how he was able to keep getting gigs after he first got his foot through the door. Simply, no one bothered to check his credentials. Every medical center, professional organization, and academic department that invited him to give a workshop assumed that the previous medical centers, professional organizations, and academic departments had already done so.

As a well-respected cardiologist–in this case, a real one–explained, "Somehow you've gotten the name or seen them in the [published] literature." And so why bother to check on his credentials yourself–if he's good enough to speak at other hospitals, why wouldn't he be good enough to speak at yours? Once the ball gets rolling (see here for a related post), the lazy assumptions of the rest of us are what allow ruses and exaggerations like this to flourish.

It's all fairly reminiscent of the way we act in other crowds as well. Think about the famous psychological studies of bystander apathy, which demonstrate that people become less likely to get involved in an emergency when they're part of a group than when they're on their own. In those studies, diffusion of responsibility often prevents individuals from offering assistance–they simply assume that someone else will take care of things.

When everyone assumes that a neighbor will phone the police, no one ends up phoning the police. When everyone assumes that someone else has vetted the supposed expert, no one ends up vetting the supposed expert.

And yet another explanation for our typical failure to help in a group is that individuals often assume that everyone else must know something they don't. When you board the subway train and notice the passenger across the row slumped over with his eyes closed, your first move is to check out the responses of those around you. They've been on the train longer than you have, so if they're not concerned, why should you be? Perhaps they've been watching this guy drift in and out of sleep for several stops now.

Drawing conclusions about the reactions (or lack thereof) of your fellow commuters isn't too different from drawing conclusions about a purported expert. Once again, if everyone else is inviting him to speak at their program, it seems reasonable to assume that he's qualified.

Cases like William Hamman's capture the imagination. It's fascinating to learn about someone managing to dupe seemingly intelligent people for sustained periods of time. This story of the airline pilot who passed himself as a doctor practically begs for a movie screenplay. One inevitably with Leo DiCaprio in the lead.

Still, as captivating as these tales may be, in many respects, they're anything but remarkable. They rely on completely ordinary assumptions and social processes that we make use of on a daily basis–tendencies that simplify our social world and help us get through life more efficiently. Obviously, however, these are also processes that can be exploited by others, intentionally as well as unintentionally.

Because there's really no reason to think that these are tendencies that most of us will curb anytime in the near future. Even having learned of Hamman's story, are you going to ask to see your dentist's degree next time you're in his office? Or ask your pilot for her license next time you board a plane? Unlikely. Though I suppose you might now do a double take if your physician ever reminds you of the importance of returning your seatback and tray table to their fully upright and locked positions.

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