H. Dominic Covvey, National Institutes of Health Informatics
The last sin-full installment addressed eLust, eGluttony, eGreed and eSloth, the first four of the seven deadly sins that afflict eHealth professionals. I’ll explore here the last three sins, eWrath, eEnvy and ePride. My hope in writing this is that it might help us understand what the roots of our mistakes in eHealth are. After all, we have seen foolishness, naiveté and, at times, criminal behavior (as occurred here in BC) set back, on a national scale, our progress towards realizing the value of eHealth. It seemed timely to remember that all human endeavors are afflicted with our weaknesses, and knowing about those weaknesses is, perhaps, a positive step towards avoiding them. I’d again like to thank my son, Mark, for the artwork!
Wrath is having inordinate feelings of anger and hate. It is the violent sin that underpins feuds, like the Hatfields versus the McCoys, and that sometimes pits whole religions or societies against each other, or even us against ourselves. Often wrath is a reaction to a grievous wrong, real or perceived, of one person or group against another.
Fortunately, I have seen nothing in eHealth that has gone as far as violence. However, I have seen people subjected to intense anger because they failed at delivering something that another was depending on, or received favoritism denied someone else, or got kudos that were perceived as misdirected. In instances like these, the angry party has sometimes struck outward to ‘get even’ or to just blow off steam. There have, though, been murders in the hallowed halls of academia and the mundane halls of business because someone perceived that ideas were stolen, credit filched, or advantages given to a colleague that were seen as undeserved.
I’ve often thought , now that I’m retired, how much easier it is now to give credit to or to share credit with others. Earlier in life, we’re just too focused on climbing the ladder!
One reason why eWrath has occurred in the eHealth domain is what I’ll call ‘personalization’, where people wrap themselves in, or almost ingest, their projects, the systems they create, the organizations they develop, or other work they do. In other words, the distinction between self and work is lost or at least fuzzed. So, if someone criticizes what they’ve done, it’s actually a criticism of them. Other causal factors may be over-dependence of one’s self-esteem on one’s work or its products, and an inability to appreciate the value of others. I’ve often thought , now that I’m retired, how much easier it is now to give credit to or to share credit with others. Earlier in life, we’re just too focused on climbing the ladder!
My point is that, if we’re wrapped too tightly and too focused on ourselves, our accomplishments, our advancement or our success, we are going to get infected with eWrath, losing perspective and ultimately hurting ourselves and possibly others.
Many have heard the word ‘covet’ and that’s what envy is about. It is the fraternal twin of jealousy. Thomas Acquinas called it a kind of sorrow for another’s good, writing about envy that it is “self-inflicted pain [that] wounds the pining spirit, which is racked by the prosperity of another.”
eEnvy is what we can feel when someone else gets a grant, an opportunity or a job for which we competed and failed. It can also be our reaction to another CIO succeeding in getting a truly adequate budget, a great deal from a vendor, or a picture in Canadian Healthcare Technology. Worse still, this feeling can fester, significantly reducing our effectiveness and depressing our job satisfaction. It, like eWrath, can go even further, including speaking ill of or taking action against another. eEnvy is a slow-acting but particularly toxic idiopathic poison. I’ve seen it really damage people.
What is its etiology? Certainly, one cause is that we don’t see our own strengths, advantages and opportunities. Rather we see something as our only opportunity, and our failure to realize this opportunity as someone else’s fault. I have seen organizations wallow for many years in poor systems and little progress, and then, after a new CIO or CEO comes in, the entire picture changes for the positive! It wasn’t that other CIOs/CEOs there were doing better or graced with better situations. Rather it was that the incumbents here were not credible, convincing or possessing adequate leadership skills.
There are many things that can reduce the feeling or impacts of eEnvy. One is to understand fully our own limitations and work to expand and deepen our competencies. Another is to get out and relate with and learn from those we might eventually envy. There may also be a need for some degree of self-evaluation to make sure we’re really fit for our roles. And, one other thing: we need to initiate a chain of successes that start from the small and grow in importance so that we have things of which we’re proud…or, in some instances, just pleased that we tried.
Somewhat obviously, a degree of pride in who we are and what we’ve done is essential. That’s a component of self-esteem. But, pride, in the sense of sin, is the ultimate sin. It is feeling and acting as if we are more important than others, intense self-love, and the view that others and their acts are lesser and that they are ‘Untermensch’ (sub-human or sub-me). All the other sins depend to a degree on the sin of Pride, and religions have seen it as the ‘Original Sin’ that got the occupants of the Garden of Eden evicted.
ePride is where we see our products and ourselves above all others, and others’ work as less important and valuable. Some degree of ePride can be a strength: we believe in ourselves, our work, our vendor, our mates and so on. It becomes pathological when we put these our-things above everyone else’s things and crown ourselves King of the Domain. ePride can be seen in every sector. In industry, we see this when someone views other vendors and their products as inferior and unworthy of existence or use. In eHealth, I have known of instances where particularly ePrideful people have become fifth columnists and undermined the perception of the work of other organizations or individuals (in at least one instance by someone who would benefit financially as a result). In academia, this is a constant problem because the ponds are so small, the situations so competitive and the academics all see themselves as so smart. In other small ponds, like hospitals or regional health organizations, ePride is very prevalent and can become a major barrier to co-operation.
Dealing with ePride is challenging. A little ePride is a good thing, but toxicity follows its hypertrophy. My sense is that each of us has the responsibility to assess ourselves (and get help doing so) and to recognize what we are compared to what we need to be. If we do that, it will be very difficult to become too full of ourselves. Regular peer review and personal, honest introspection seem essential. If we know someone whose ePride is damaging to others, we can start by engaging with him or her and discussing why this is ultimately self-destructive and well as causing a bad situation for others.
I remember in high school (a Catholic one, you could easily guess), we were discussing Extreme Unction (a rite now called the ‘Anointing of the Sick’), and our teacher pointed out that the 5 senses with which we could sin were anointed. One of the curious students (or was it the wise guy?) asked the teacher: “How can we sin with our noses?” The teacher, not missing a beat, said: “Well, if you think I’m going to tell you that, mister, you’re mistaken!” I expect that I have not raised new ways that all of us can screw up, but rather hope that I have pointed out things that are human foibles and that are at the root of many of our more elaborate misbehaviors. Maybe this will help all of us understand the roots of those misbehaviors and gradually minimize them to the benefit of ourselves and all those with whom we interact.
Dominic Covvey (FACMI, FHIMSS, FCIPS, SMIEEE, ITCP) is an Adjunct Professor at the University of Waterloo and the University of Ontario Institute of Technology. He is also the President and Director of the National Institutes of Health Informatics. He was the Founding Director of the Waterloo Institute for Health Informatics Research at the University of Waterloo (2003-2010). His research is in the representation and analysis of healthcare workflow, the definition of competencies and curricula in Health Informatics and the design of the Electronic Health Record.