Change Reality, in Your First Year of Medical School, with Kevin Maloy, MD & #MakerDocs

2017.05.17 Hacking Healthcare Georgetown University School of Medicine Washington DC USA 5040
2017.05.17 Hacking Healthcare Georgetown University School of Medicine Washington DC USA 5040 (View on

When I was a first year medical student, no one offered to help me create software (I did it anyway, really simple stuff). In 2017, at Georgetown University School of Medicine, first year medical students go through the software creation lifecycle in a selective “Hacking Healthcare.”


It’s taught by Kevin Maloy, MD (@MaloyKr), aka MakerDoc aka Change Reality, Talk about Magic, Learn Javascript. MakerDocs DC from this blog in 2014.

Kevin asked me to come give feedback to this year’s class, and per my policy, if I can walk to it, I’ll do it 🙂 .

This year, they had the expert guidance of John Lock, the ridiculously more-experienced-than-I-will-ever-be Entrepreneur-in-Residence at the famed Mi2 Medstar Institute for Innovation, and fellow feedback provider Dave Milzman, MD, FACEP, Associate Dean for Student Research and Informatics.

For me, it’s less about what the teams create (because by definition they are exceptional people and will create great things in their lives), and more about the way they create, and the heart and soul they integrate along the way. I could tell in 7 sessions that they learned how to

  • Tell a story about why something matters
  • Understand a real business need and how to prototype to it
  • Work through others to execute on a vision
  • Collaborate as a group

These are all great skills I know they, their patients, and their communities will appreciate later on. Some people work entire careers to master these.

I don’t know how stealthy the ideas are so I won’t reveal them. I was super impressed at the connection of the ideas to actual health, AND the design ethic that they brought to the work. I can see how a medical school would do well to create a learning experience like this, capture the spirit, and then check to make sure at every step of training that it grows and thrives.

It’s always a pleasure to meet a new generation of MakerDocs, and to meet them under the watchful eye of W. Proctor Harvey, MD, especially when you read what he stood for:

A strong advocate of the human touch in medicine, Dr. Harvey had a gentle bedside manner that extended to shaking hands with every patient and plumping up their hospital-room pillows. He believed modern physicians had become too dependent on technology and other diagnostic tools and had lost the ability to work with patients on a simple, person-to-person level.” – Washington Post, 2007

Just Read: Moral Self-Licensing – a continual challenge to eliminating bias in health care

Earlier in my career, I remember a colleague saying to me, in a challenge to observed, biased behavior, “this is organization x, those things don’t happen here.” He said it with a dismissive chuckle. And yet, it did happen…

I have been intensely interested in the concept of “Illusion of Objectivity” especially in health care, and so have done a deep literature review. It brought me to several helpful papers and the concept of moral self-license (Merritt AC, Effron DA, Monin B. Moral Self-Licensing: When Being Good Frees Us to Be Bad. Soc Personal Psychol Compass [Internet]. Blackwell Publishing Ltd; 2010 May [cited 2016 Aug 13];4(5):344–57).

One of the authors, Daniel Effron now at London Business School (@lbs), has written another piece more recently which I’ll post on next.

It’s yet-another-place where the professions outside of medicine can teach us a lot, and why shouldn’t they, we need each other, and our patients need us to perform our best for them.

Moral Self-License, a fascinating concept that shapes our actions

When under the threat that their next action might be (or appear to be) morally dubious, individuals can derive confidence from their past moral behavior, such that an impeccable track record increases their propensity to engage in otherwise suspect actions. Such moral self-licensing (Monin & Miller, 2001) occurs when past moral behavior makes people more likely to do poten- tially immoral things without worrying about feeling or appearing immoral.

Several study situations of note (summarized here, you can review for control situations, etc):

  • When people expressed support for a Black presidential candidate (Barack Obama), they were more likely to subsequently express bias toward less-qualified White candidates for a police job.
  • People asked to describe a time in their past when they acted immorally were more likely to endorse prosocial activities such as giving to charities.
  • The converse situation, people describing a moral act in the past were more likely to cheat on a math task

So there is something about doing (or even thinking) about past behavior that causes people to engage in less-than-virtuous behavior or to minimize the less-than-virtuousness of the behavior.

What does this mean for health care?

A lot.

There is much public controversy presently around institutions and people who express commitment to an unbiased environment, and yet biased environments persist.

Interestingly, further research shows that there is greater sensitivity to what is seen as hypocrisy by people in the affected, targeted groups, which makes sense. The converse, however, is that people who are not in the targeted groups are less likely to see hypocrisy and license biased behavior, which allows it to persist. This is a difficult problem if the actors and the licensors are all part of the same ingroup – there will be less introspection.

Here’s a reason why this is important

Explicit attitudes among medical students 54441
Explicit attitudes among medical students 54441 (View on

Explicit and implicit attitudes among medical students 54443
Explicit and implicit attitudes among medical students 54443 (View on

Because, today, medical students feel comfortable explicitly stating bias against lesbian and gay individuals (and even more bias against obese individuals), an atmosphere of moral license (“we don’t do that here, our policies say so”) can allow this to continue.

Note that because of the concept of impression management, students (and physicians, other research) are much less likely to openly state bias toward African American individuals, even though their behavior may reflect it (see: Just Read: Eliminating physician biases against gay and lesbian people, don’t forget the “T” ) .

Who I am vs What I do

There appears to be a protective effect in the understanding of a person’s commitment (who they are and what they stand for) versus what they do (progress toward a goal). Labeling is tied into this:

several studies have found that labeling people as ‘‘helpful’’ after they agree to a small request increases their likelihood of acting consistently by agreeing to a subsequent, large request

Value of Listening, Introspection

There are a few more papers that I’m going to summarize here, because this is such a fascinating topic, and frankly, a head scratcher for people in vulnerable groups who observe repeated, biased behavior in people who otherwise are committed to being bias free.

The reconciliation of all of this is that we are all human, and the “this doesn’t happen here” turns out to be one of the most dangerous statements that can ever be made.

As I reflect on some of the most impressive leaders and concepts I have seen/heard, they involve listening better (“Just Read: Just 6 more seconds of listening needed to elicit the patient’s agenda“) and understanding that improvement is always possible (“There’s Always Something to Do Better” – Medical College of Georgia, home of patient and family centered care). In the latter concept, just think about the statements from people who say they always want to get better and how compelling they (and the people behind them) are.

Working to be an Ally

Right now, I think one of the most topic areas for this exploration is the work of being an ally, to a group of people that is not your own. This is a space where the research points to a great risk of moral license (because the actor and the target are not in the same ingroup), and where, consistency is needed the most for the persons an ally is working to support.

Maybe good advice here is to be introspective about actions, query those who you are working to be an ally for about actions, and listen to their answer. Otherwise, a person may be inadvertently licensing themselves to do things they will not notice are unhelpful, and later regret. It’s what all humans do, therefore, work with other humans to mitigate this risk :).

This is still one of my favorite quotes (from: Not using the term “Transgendered” and respecting people) :

**Don’t get defensive**

If you get defensive, notice it and accept the discomfort of unlearning and relearning

This requires a desire to know, motivation to become informed, willingness to correct mistakes

A tour of/from the future, Georgetown School of Medicine, Washington, DC USA

E Pluribus Innovator View on Flickr

After a long delayed scheduling process (medical students are BUSY), I got to take a tour of the medical education experience of fellow future inhabitant Konstantin Karmazin (@zenkkarma) at our local medical school with a family medicine department (@GUFamilyMed),  Georgetown University School of Medicine.

From time to time I end up in medical schools, even though I don’t work in one, just to see how the future is coming along, because when you live in the future, you need compatriots :).

As most medical schools today, you can tell just from the architecture how medical education is changing. As I pointed out on a previous visit to Wayne State University (My crazy life ride with Regina Holliday, at #TEDxAlvaPark , Detroit Michigan, USA | Ted Eytan, MD), the model for medical school buildings was previously the shape of a tomb. Newer medical schools and buildings attached to incumbent schools reflect more of the openness of the medical profession (see: Dreaming for the Future – at Lake Nona Medical City, Orlando, Florida | Ted Eytan, MD). The 60’s and 70’s were definitely a distinctive time for architecture!

As we talked about the current medical education experience, I reflected on my own journey, with the innovation for its time being “email” (and it was not well received when I brought it up – “History isn’t something you look back at and say it was inevitable”). Today it’s a “whole bunch of other stuff” (but actually email is still not the norm between patients and physicians in medicine … ) and there’s still a need for people to connect their passion for medicine and science and health with the demands of medical education and interest in the future. It’s still really hard.

One advantage today is the greater availability of networks and especially in Washington, DC, the most social city in the United States (it’s why we’re here and how we connected – the system works!). Mentorship isn’t something that came to me until after I finished medical school, and now it’s everywhere for me – co-workers, patients, fellow physicians and physicians-in-training. You can’t discount the value of someone saying, “you know that thing you’re doing that’s different than everyone else, keep doing it, it’s really important.” That still happens for me (and from me to others), makes a huge difference.

Speaking of journeys, thanks for the walk, all the best discoveries happen that way….

My crazy life ride with Regina Holliday, at #TEDxAlvaPark , Detroit Michigan, USA

As we were walking out of the #TEDxAlvaPark speaker dinner at The Henry Ford (@TheHenryFord) the night before the event, I asked Regina if we should make any changes to our talk, now that we had interacted with the other amazing, accomplished presenters. Her response frames the title of this post:

So that’s what we did. Our slides are below, the YouTube video is coming soon, and here are the live tweet photos I took of Regina from the stage:

Get it? It was amazing.

What we did the day before was also amazing. When I asked Regina if she would rather (a) Go to the Motown Museum and see the room where Diana Ross changed history or (b) Go to Wayne State Medical School , tour by Phil Kucab (@phillipkucab), she chose the Medical School. Why? Because she’s on a mission, and she wants to learn.

So we went, and I saw so many artifacts that showed that medical education is changing. There’s a small medical student art gallery. The ping pong room (every medical school has one), has a make shift photo studio where Phil photographs people for World AIDS Day Detroit (@AIDSdayDetroit). These may be imperceptible to the students there today, but I sure noticed them because I had access to neither, much less to a patient advocate visiting me when I was in medical school.

Regina says I tend to notice things on the edges that are significant (to me anyway). When I picked out my favorite photographs of the trip, I realized that they are of the moments of flow, where Phil was showing us his world from behind a grand piano, Regina inspiring Allison, Phil’s colleague, who has an art history background and beautiful photograph on display, me watching Phil and Regina talking over lunch and thinking, “I’m trying to keep up with these two.” It’s life in the innovation clown car. I never want to get out of it.

As I have said on here before, I don’t use a camera to take pictures, I use it to capture the beauty of the human spirit. I took so many photographs in just 24 hours, many more than I usually do, which tells me something about what I found in Detroit with Regina :). Below are my favorites, you can access the whole collection here.

With great thanks to our hosts at the Henry Ford Health System Innovation Institute (@HenryFordIdeas), and the institution it supports, is part of, and trains a new generation of leaders. The woman in the sunglasses, by the way, is Taryn Simon, our most excellent host, who unfortunately was in a car accident the day before. She’s doing fine, but I had to get a few shots of “Texts from Taryn” , don’t worry, there won’t be a Tumblog with this one :).