Autonomy, Purpose, Mastery

I love these RSA animations & I love the Brain Pickings newsletter that found me this. If you don't know, Brain Pickings is the best curated interestingness compilation on the internet, in my opinion. 

This piece of interestingness, is the science behind why mo' money does not lead to better outcomes. 

It applies to corporations, employees & small businesses - In particular I'd like to point out how it applies to doctors in a fee-for-service (or membership-based) model. 

When it comes to cognitive performance (let's say diagnostics or coming up with useful, individualized health solutions), the more money that is placed in front of the doctor as a motivator, the worse they perform. 

The worse they perform. If you don't believe me watch the video. 


Medicine is not a physical task, it is a purpose driven, cognitive & emotional career. We fit perfectly into the data set mentioned in the animation.

Increasing the reward ($$ per patient) does not help a physician treat better, though it may fatten wallets, and allow a higher social status. Financial freedom is not a bad thing, but given this evidence, we are using an ineffective method to match great work with financial gain.

When it comes to career, passion, sense of identity and pride, if money is the dangling carrot, we not only feel but act like puppets rather than self-directed individuals. We actually lose our cognitive spark and we just don't create great results. 

We are purpose-maximizers, not profit-maximizers.

What we really want is:


We want the freedom to be self-directed. For our own ideas and explorations to have space to grow. This is why some amazing companies are started by people who have full time jobs doing something else. As a doctor, there are two ways this can occur:

  • To build ongoing, honest and caring relationships between patients and doctors, so defences are down, liability is softened and everyone feels safe when a doctor makes a recommendation. This type of relationship allows space to come up with innovative solutions that are individualized, prioritized, and possibly even researched on their time off. In privatized care, this ongoing care is only available to those with disposable income.

  • To not have a governmental system breathing down their neck, with quotas and stats and coding and billing. Privatized care has this part down pat. This overbearing type of accounting takes away freedom to do what the physician may think is best - which might be an un-billable service. To put the autonomy back in the physician's hand, we need to build trust and accountability between the patient and the physician. 



- we love the opportunity, in fact we will give up many hours of other opportunities, to spend time getting better at something we are passionate about. Call it obsession, call it dedication, call it what you will - but if you love something, you will irrationally pour your unpaid hours into it. As doctors,  if a case is not tied to a $$ sum per person, they would put in the amount of time it takes to learn about the case. Sometimes it could take a few minutes, sometimes, it could take days of research, depending on individual mastery of a topic. If we stop looking at physicians as workhorses, using amount of time spent on a patient as an indicator of care - and start allowing physicians to master the art of case care, we get great care in 7 minutes or 30 minutes or 60 minutes. This is what specialists are given space for. Why can't we create that space for general family practice? 



- This is the "why" of life. Why we want to do the work we do. Too often, medical students come into their educations with a huge sense of purpose - and as they get shuffled through the system, they realize that with the current model, they are not going to make a living unless they prioritize quantity and bill-ables per patient. This exists in both privatized and public healthcare. The profit incentive model has made us lose focus of our purpose. "When profit is unmoored from purpose, bad things happen." Ethics starts to slide down slippery slopes, competition becomes catty rather than inspirational, and medicine becomes a product on the market. 

The best use of money as a motivator is to pay people enough to take the issue of money off the that they are thinking about the work.

In my interpretation, if we can pay our doctors enough to feel secure, sustainable & supported, patients will get better care, and we will all feel better.

Change is not low-cost health care - it takes the issue of money away from the visit. Your doctor may be more creative than they thought possible. Why? Because if you've never had the wings, you've never thought you could fly. Change is a set of wings for your doctor. The more they soar, the more you soar.

Are you convinced? Change is the future of medicine. It allows for doctors to be autonomous, to master the art they love and to feel the purpose of teaching and healing, unattached to a financial transaction, without financial losses. Sign up with a Change practitioner today. It's really the best way for more people to get high-quality care.