| May 201122

Integrative CareBusiness & Practice

The Dangers of GroupthinkBy William Morgan, DC

The term “groupthink” was coined by the psychologist Irving Janis in his 1972 work, Vic-tims of Groupthink: A Psychological Study of Foreign-Policy Decisions and Fiascoes. Groupthink describes what happens when individual thought cedes to the will of group consciousness. This may sound like a cross between an Orwellian novel and a bad

zombie movie, but its prevalence in the world is common, and the dangers of groupthink are all too real, es-pecially when it comes to decision-making in health care. Groupthink suppresses dissenting views and can lead to an oversimplifi ed view of problems and solutions.

Symptoms of GroupthinkDr. Janis presented eight

symptoms of groupthink:• Group attitude of invulner-

ability. The group feels that it is “bulletproof,” so it takes unnecessary risks and is over-ly confi dent.

• Group rationalism—discred-iting evidence that is con-trary to the group beliefs.

• Group peer pressure inhibits the will to dissent. Mem-bers of the group are brow-beaten into conformity of thought.

• Group belief of moral superiority.• Stereotyping of outsiders in negative terms—such as “Oh,

he is just a dumb straight.” Or, “Those medi-practors are so insecure in their ability to adjust.”

• Group self-censorship. Peer pressure and stereotyping cre-ate a spirit of self-censorship. The team members censor their own words and thoughts.

• Group complacency is fed by the group’s culture of self-censorship and peer pressure.

• The appearance of unanimous decisions. Since no one voices a dissenting opinion (because of peer pressure, self-censor-ship and stereotyping of dissenters), the group feels that it always has a unanimous consensus.

Several failures have resulted from groupthink: the Maginot Line, the Y2K millennium bug hoax, global warming (both sides of the argument) and the Challenger space shuttle disaster.

In health care, we see groupthink dangers when treatment risks are considered acceptable by certain specialty groups. Physi-cians in a group may discuss the nuances of a surgical procedure, but they do not question the need for surgery. Another medical specialty may dispense pain medication while rationalizing the risk-to-benefi t ratio. Equally disconcerting are health care ad-ministrators and decision-makers who issue decrees for the rest of society while cloistered away in a boardroom far from the treat-

ment room.

Protect YourselfOf course, it would be hypocritical for us not

to refl ect on our own profession. Certainly, when chiropractors get together, we can be as guilty as anyone else when it comes to groupthink. How

can we protect ourselves? When-ever we meet in groups, boards or committees, we need to identify

the risk of groupthink and take ac-tive steps to prevent its insidious-ness from creeping into our midst.

Group leaders should seek input from those with dissenting views. The organization should encourage open discussion and feedback. Hav-ing someone play devil’s advocate would also be a way to infuse open thought into our organization.

Seeking input from outside the group provides a healthy look at outside opinions. For example, at the hospital, I frequently call upon other physicians for their opinions in complicated cas-es. Finally, group leaders should avoid stating their opinions so strongly that the entire organization is coerced into marching in lock step with them.

Though Dr. Janis coined “groupthink” in recent decades, the tendency has been recognized for centuries. Hans Christian An-dersen illustrated it eloquently in his story “The Emperor’s New Clothes”, when a little boy broke the trance of national group-think by blurting out that the emperor had no clothes. We need to echo the little boy’s sentiment in defending our profession from the ill effects of groupthink..

Dr. Morgan splits his clinical time between a hospital-based chiropractic clinic and two Washington, D.C., executive health clinics. He is adjunct faculty for F. Edward Hébert School of Medicine, Uniformed Services Uni-versity of the Health Sciences and New York College of Chiropractic. He can be reached through his Web site, www.drmorgan.info.

Group leaders should seek input

from those with dissenting views. The

organization should encourage open

discussion and feedback. Having

someone play devil’s advocate would

also be a way to infuse open thought

into our organization.

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