The Wiki Man

This strategy won Eurovision. It could also save your life

Sometimes it’s better to be brave than good

24 May 2014

9:00 AM

24 May 2014

9:00 AM

Oskar Morgenstern grew up in Vienna, John von Neumann in Budapest. Clearly the same Austro-Hungarian intellectual spirit which gave rise to Zur Theorie der Gesellschaftsspiele and their seminal joint work Theory of Games and Economic Behaviour is still alive in that part of the world, because the Austrians chose a bearded transvestite to represent them in the Eurovision song contest. Oskar and John would have been very proud.

If you want a really childish explanation of game theory, it is that when everyone else goes around shouting ‘rock’, a few smart people should start to shout ‘paper’. And perhaps a few really smart and really brave people, figuring out this ‘paper’ strategy in advance, might even be emboldened to shout ‘scissors’. In Eurovision this year, Poland shouted ‘paper’; Austria shouted ‘scissors’.

The cunning real trick here is that, if you want to win Eurovision, it is better to do something distinctive than to do something conventionally good. That is not to say that the distinctive cannot be good or even great (France Gall’s and Serge Gainsbourg’s 1965 winning song ‘Poupée de cire, poupée de son’ was booed in rehearsals simply for not being a standard ballad; ‘Waterloo’ was highly unusual at the time). But the fact is that, even if you miraculously produce a conventional song that is 10 per cent better than the 15 other conventional ballads you are competing against, that 10 per cent advantage is never enough to drown out all the noise created by regional voting blocs, national rivalries and so forth. Better to go all or nothing — ‘Monte Carlo or bust’ — in this case by fronting someone with the second most famous facial hair of any Austrian in history. That way you will either win spectacularly or lose spectacularly, but you won’t end up coming fourth just because the bloody Scandies all voted for each other again.

The reason more people don’t try this is simple. It takes courage. When you fail conventionally you get sympathy; when you fail unconventionally you get blamed. It’s a behavioural bias known as defensive decision-making, and it affects almost everything.

When making any choice, our first instinct is not to choose the ‘best’ answer but the answer which minimises the harm we personally can suffer in the worst-case outcome. (‘Minimax’ is what John von Neumann calls this). Let’s say I have the deciding vote on Austria’s entry to Eurovision: if I pick some boring but worthy schlager and it loses, I keep my job. If I choose a drag artist with a beard and she loses, then the finger-pointing begins.

This defensive decision-making explains why bureaucracies are so inefficient. It infects middle management at large companies, making them incapable of innovation. (It also explains why entrepreneurs, being beholden to no one, are so valuable.)

More worryingly, defensive decision-making may kill thousands of people every year. As Gerd Gigerenzer explains in his new book Risk Savvy (already my candidate for the best book of the year), a vast proportion of medical tests, interventions and referrals are unnecessary. They make no sense statistically, but the doctor is instinctively afraid he or she might be sued for not performing them.

This, to me, raises a significant question. Could the NHS be made significantly better if patients were free to waive the right to sue except in cases of egregious incompetence?

I would willingly sign away my right to sue as a gesture of principle: put simply, I prefer money to be spent on doctors than lawyers. Moreover, if Gigerenzer is right, it might actually improve the quality of patient care. If any doctors are reading this, I’d like a second opinion.

Got something to add? Join the discussion and comment below.

Rory Sutherland is vice-chairman of Ogilvy Group UK.

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Show comments
  • CD Villneuve

    “I would willingly sign away my right to sue as a gesture of principle” – come off it Rory, you’re with Bupa.

    • transponder

      Titter. And quite right, too, if he is!

      • rorysutherland

        I would certainly sign away my right to sue BUPA as well – I use both. Richard Thaler suggests in “Nudge” that Americans should have the right to cheaper healthcare in return for signing away their right to sue in all but extreme cases of malpractice. This would reduce costs and conceivably improve patient outcomes a lot, since doctors would be free to avoid the “I must be seen to do something” bias.

        My grandmother and my mother both suffered from quite serious medical mistreatment. In neither case did we sue – for one thing my grandmother was the widow of a GP and would never have sued a doctor; for another thing, we’re just not the kind of people who do that.

        Which raises another question – why should people who are not naturally litigious subsidise people who are? Litigation costs for the NHS are expected to rise above £15bn over the next few years. I am sure some of this money is very well deserved. But much of it could be better spent on improving the future rather than redressing the past.

        • CD Villneuve

          David Ogilvy would be glad to hear you use BUPA Rory, he was a great man for encouraging his staff to be customers of his clients.

          • rorysutherland

            And on ethical grounds I don’t think you should advertise anything you wouldn’t be happy to use yourself.

        • transponder

          Excellent points, all.

          I hate to think of anyone suffering from medical mistreatment. I’ve been, mildly, on the receiving end of it myself — but it had the cover of an unjust general practice, so it would be hard to criticize one particular instance of it. I think that women have often been treated disrespectfully, in ways that men mainly aren’t, in general.

          The worst instance of something going horribly wrong — whether it was actual malpractice I’m not sure — that I know of is the case of the archaeologist who had a double mastectomy on the advice of her doctor and it turned out she had no cancer at all.

  • Gav Gray

    Thanks to you Rory, I’ve just ordered my FOURTH book by Gerd Gigerenzer. You should be collecting royalties from Book Depository! Gigerenzer’s book “Calculated Risks” is one of the best books I’ve ever read. Looking forward to getting stuck into “Risk Savvy”

  • transponder

    I wrote about the first most famous Austrian hair in history, and I lost spectacularly. And: I was good. Anyway, I agree with the article, but I would also add that life is a crapshoot, especially if you lack backers.

    • pedestrianblogger

      You were, and are, very good indeed.

      • transponder

        : )

  • Guest

    Not a transvestite, btw. How very 90’s of you to say so. So very behind the times.

  • Chris 99

    As a GP, my perception is that the amount of excessive investigation which goes on in hospital medicine (CAT scan this, MRI that, biopsy the other just in case) seems inversely related to (a) the age/experience of the doctor, and (b) the extent to which the patient’s care is privately provided. In the case of (a), younger, less experienced doctors are generally more risk averse; a culture of risk aversion is propagated in the UK’s medical schools. This is perhaps no surprise as there is a relentless rise in medical litigation; this spectre scuppers innovation and snuffs out the caritas which used to be the hallmark of the benevolent doctor.
    In the case of (b), my experience is that privately-insured patients are very often over-investigated, which gives the impression of a much more ‘thorough’ (and by extrapolation, ‘better’ service (even if the outcome is the same)) than the resource-limited NHS can provide. There is big money to be made – witness the increasing involvement of private healthcare organisations in NHS waiting-list work – but that is another matter.
    As GPs, we often see complex, undifferentiated illness presenting with generalised symptoms (for example, cancer presenting with symptoms typical of irritable bowel syndrome – leading to those popular tabloid stories along the lines of ‘I saw four GPs with my bowel cancer and they all fobbed me off by telling me it was just IBS’; in this case, the third and fourth GPs could perhaps be more fairly held to criticism than the first and second for ignoring repeated presentations with similar symptoms). Unfortunately, it is a fact of life that the extraordinary often presents as the ordinary, and for as long as doctors feel they will be criticised and vilified for ‘missing’ diagnoses, human nature dictates that they will err on the side of caution – a sort of medical Pascal’s wager, if you will.
    My experience of the legal profession near medicine is that they provoke a culture of defensive, over-investigative practice. If they, and politicians, kept a safer distance from medicine, I think it would lead to a healthier,and more affordable, NHS for us all.