Mental models, medical misunderstandings, and expressive and instrumental behaviour

By Gordon Rugg

A frequent and enduring topic of complaints about medical professionals is their bedside manner.

Three common complaints are:

  • My doctor won’t listen to me
  • My doctor is cold and impersonal
  • My doctor doesn’t give me the facts

These can be explained and handled via the concepts of instrumental and expressive behaviour. Instrumental behaviour is about getting the job done; expressive behaviour is about showing how you feel about something. I’ve blogged about these concepts and their implications here and here and here.

These categories are not mutually exclusive; some people are very strong both on instrumental and on expressive behaviour, for instance. However, people tend to incline more to one than the other. The “people person” with good social skills is typically good on expressive behaviour, while the archetypal “techie” is strong on instrumental behaviour.

The issue of expressive versus instrumental behaviour is a common cause of serious misunderstandings across many domains; medicine is a classic case. Fortunately, many of these misunderstandings can be fairly easily prevented. In this article, I’ll describe the underlying concepts, and how to use them to reduce the number and severity of complaints.

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Mental models, and games people play

By Gordon Rugg

There are patterns in the ways that people interact. This article is about those patterns, and their implications.

I’ll start with a pattern known as “Ain’t it awful”. In this pattern, the other person wants you to agree with them that things are awful. I’ve shown this diagrammatically below. The interaction starts with you saying something; I’ve shown this with a white circle. They then respond with something negative, represented by a grey circle. For instance, you might tell them that you’re thinking of buying an electric car. They react by saying something about problems with electric cars.

They now want you to respond with something negative; for instance, “That’s the trouble with new technology, you can’t depend on it”. The interaction is then supposed to follow the same pattern of “Ain’t it awful” in a nice, predictable way, as shown below.

This may be nice and safely predictable for them, but it’s not so nice for you if you don’t want to be told about things being awful, and it’s not so predictable for you if you’re expecting a different type of interaction.

In the rest of this article, I’ll look at ways in which interactional patterns can play out.

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