By Jane La Mantia de Pencier

Biting the hand that feeds you is considered an unwise act, unless you work with the Health Strategy Innovation Cell. I think us “Cellies” like it, at least we like a little nibbling, and so I want to roll over a few thoughts on the topic of Healthcamp Toronto. If I disappear like Deng Xiaoping you’ll know why.

I’m thinking about China. Actually what brings me to thoughts of China is the phenomenon of groupthink. I’ve been trying to form an opinion about groupthink. It’s referenced everywhere these days in social media and trending. I’ve been trying to come to a dramatic example of groupthink in action.

The Proletarian Cultural Revolution comes to mind as described in Nien Cheng’s
Life and Death in Shanghai. The author describes organized groups of young people, The Red Guard, tearing through the city burning books, smashing ancient porcelain and musical instruments, urinating on early dynasty furniture and walloping intellectuals about the ears.

“As they crowded into the hall, one of them knocked over a pot of jasmine on a Fen T’sai porcelain stool. The tiny white blooms scattered on the floor were trampled by their impatient feet...

‘We are the Red Guards. We have come to take revolutionary action against you .’”

Was this an example of groupthink? Well, it was certainly group behaviour, but the extent to which it can be called groupthink is unclear. Healthcamp Toronto galvanized by my Cell colleagues attracted a committed group of participants. All were invited to offer opinion and share concerns on patient-focused healthcare issues.

The goal of any Healthcamp is to provide a live and cyber gathering place for healthcare discussion and launching ideas into action -- in an organic, unstructured way. There are a lot of people who have dedicated much thinking to patient-led change, and it seems that it can only be fruitful to bring them together.

Is there trouble with this? No. This only becomes troubling if the tone of the conversation becomes hyperbolic. It is only a concern if everyone agrees and no one listens. It is a concern if a vocal few move a majority of the participants in a way that is only emotional and unflavoured by an intellectual temperance.

There are measurable changes in the world of medicine, and in 2009 there is a growing culture of collaboration among professionals. With the social media available to us today, it seems not only promisingly effective for us to communicate with each other, but it also seems so easy it’s immoral not to do so. Here’s why: each of us owns a body and a certain expertise. There is not a layperson among us on this matter. So, in a forum like this we may have a number of experts expressing highly informed and experientially biased points of view.

I think any moderator of a successful Healthcamp will need a strategy for spotting an insidious drift as well as a positive wave, and a moderator may need to bring in structure (within an “unstructured” context) to challenge the flow. It’s not that a consensus is always wrong; it’s just that consensus is usually not revelatory and sometimes it’s downright nutty. I think there should be aspirations for dissent, debate, and thought building, but no conclusions, please.

In his book The Chinese, author John Fraser notes that Mao’s state publishing house always presented his commentary in bold letters. Mr. Fraser also writes that in some editions of the Bible the words of Christ were printed in red. This was to exalt these speakers. Well, the moderator of Healthcamp does not need to be exalted, but I think a moderator might want to have some sort of distinguishing “otherness” in order to draw attention to worrisome signs of agreement that grow out of nothing other than the charisma of the crowd. Is there to be a moderator at all? Can a crowd ever moderate itself? Is there such a thing as too much egalitarianism? Ok, so I’ve revealed myself a bit. Untempered crowds spook me.

Healthcamp is based on an idea that getting people together to talk is a lively, dynamic way to expand ideas and a wise and informed way to nurture policy. The ideal at the foundation of this is probably a fundamental belief in the value of the opinions of others. Mao didn’t want to hear the ideas of others, he just wanted them to indulge his own thoughts. The Proletarian Cultural Revolution could be said then to be a time of ‘groupthunk’ where ideas were stuck. Still, stale, stunk, or, as Mao was quoted, on the matter of The Gang of Four, “Sh*t. Wide of the mark.”

Healthcamp Toronto was part of a bottom up reformation, not a top-down revolution. Groupthank.

Copyright Jane La Mantia de Pencier, 2009