Free Lunches and Pride Investment

A few days ago, Patrick McKenzie went against the common wisdom of economists by tweeting this:

(There is a saying in economics “There is no free lunch.” which has a certain intuitive appeal but is just obviously observationally false. We live in a world where “Doctor: wash your #*{^#ing hands” before surgery saves lives.)

His thread contains some more examples:

“That thing you want more of: do you measure it with numbers?” “Have you considered taking attendance and firing government employees who do not exist”

“Prior to building the thing perhaps you should talk to the people who would use it.” “When in doubt, write it down.”

Another example comes from a 2007 New Yorker article A Life-Saving Checklist which recently resurfaced on Hacker News. It’s relatively long. The “free lunch” here is amazing increases in survival rates in emergency rooms, and can be bought for the low price of following simple checklists for common procedures.

So why is such low hanging fruit so often left unpicked? Why do governments not routinely fire employees who do not exist? Why do intensive care wards not routinely employ checklists for every procedure?

The true cost

McKenzie didn’t answer this question. Gawande, our New Yorker author, makes clear that it’s difficult to convince hospitals to start using checklists. But he doesn’t spend many words on why.

Yet casually, in passing, he sneaks in one sentence that seems to cut to the heart of the matter:

Some physicians were offended by the suggestion that they needed checklists.

It makes sense. The smartest and best trained people don’t like hearing they are too stupid to remember five steps of a common procedure. Yet, checklists save lots of lives and costs.

We try hard to see ourselves as rational and competent. We know that we don’t know everything and we make mistakes, but we hate to be reminded of this. It threatens an image of ourselves that we work hard to create for ourselves and others.

So the checklist is not that free after all. It takes swallowing a lot of pride. And this may be the dearest currency of all.

The same cost seems to be behind the difficulty of adoption of the “free lunches” that McKenzie mentions. They too boil down to “remember that you make mistakes and don’t know everything”. In programming terms, he’s reminding us of the value of wrapping our plans in if-else and try-catch blocks.

We can hear the objections coming — don’t worry, my plan will work. Don’t worry, I’ll remember it. Don’t worry, my staff are competent. These are assumptions we prefer to not even start questioning.

Investing your pride

So the only cost is mental. That explains why so few people eat these free lunches.

Mental hurdles tend to work this way: if you find them and care about overcoming them, you can overcome them easily. But you cannot do that for other people. They have to care enough, and then also take the initiative to be humble and honest enough with themselves.

If you do, though, payoffs can be huge, not least in that currency we invested in it. Once you’ve swallowed enough pride to follow a checklist, talk to some potential customers, or measure your goals, you’ll do better and better over time. This will be better for you, for those around you, for the world at large — and it will rightly make you proud.

How’s that for a return on investment?