The Magic of “Because”

I have a confession. Obliquely referenced in previous columns, but more bluntly stated: I dislike being asked for addenda to my radiology reports.

In addition to explanations I’ve offered before (such as being interrupted in the middle of my other work, feeling semi-accused of not having rendered a good-enough report the first time around, etc.), I’ve identified another, more fundamental reason why such requests ruffle my feathers: I don’t like being told what to do.

That might make me sound like an obstinate pill, so I’ll emphasize that I have no problem doing something for a good reason. And, the reason doesn’t have to be of Earth-shattering importance. If you tell me that my action might make me look better, or will make someone’s life easier, I’ll probably comply.

But, bark orders at me, or act like it’s my role in the natural order of things to carry out your instructions without any explanation for them, and good luck getting me to do what you want. Even if I do, there’s a good chance I’ll be reluctant or half-assed about it…and your political capital with me might diminish as a result.

This isn’t just me, by the way. And, it’s not restricted to radiologists, or indeed other physicians. True, docs are generally intelligent, highly-trained, and educated individuals who have gone through more than a few hierarchical levels…and that’s bound to make a person feel like they have left their scuttling, do-what-I-say minion days behind them.

People, in general, respond better when they are given reasons why they should behave or even think in certain ways. It’s borderline-magical what a “because” can do. Indeed, what follows that word almost doesn’t have to make any sense.

Case in point, courtesy of Robert Cialdini (one of the primary sources in my recent studies on the science of persuasion): An experiment focused on people asking others if they could cut in line at a photocopier. They got a lot more compliance if their request included, “because I’m in a hurry.” Even if they said, “because I need to make a copy.”

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Which, rationally, makes no sense…everybody in line at the copier needed to make a copy. But, it worked. The explanation, more or less, is that the brain is lazy, and if you give someone a reason to do something, complying is the easy way out.

A lot of folks err in assuming that the person they’re asking already knows, or can figure out, the reason for the “ask.” Or, that the differential of power/authority between them is such that no reason need be offered.

But, think about how little time/trouble it takes to speak (or write) just a few more words to give someone a “because” that will motivate their compliance. To do something more wholeheartedly, or even at all.

Imagine picking up an imaging-study to interpret. Think about how you feel when you are given a good clinical history, as opposed to when a referrer doesn’t bother to give you anything (i.e., gives you no reason for the study, no “because” to justify it).

If I’m told “Make an addendum on that X-ray you read, stating the number of views,” my grumpy/interrupted mind might immediately think, “Why should I?” If the request includes, “…because it’s required for billing,” I might not grin from ear-to-ear and joyously sing out my addendum, but I’ll feel less like I’m just being ordered around.

Didn’t I already know, at some level, that billing (hence, my compensation) or the like was the reason for the request? Yes, but my lazy brain doesn’t have to connect those dots if the requester spells it out. It goes from being something in my subconscious mind to something squarely in the crosshairs of my conscious awareness.

Similarly, if I shoot a message to my support-staff that I can’t read out a scan until they upload the prior studies, I might come across as yet another demanding rad. But, if my request includes something as simple as, “…because it’s a follow-up for lymphoma,” they are reminded why comparison with prior studies is relevant. Not to mention that someone’s cancer treatment is on the line.

Didn’t they already know these things, at some level? Again, yes, but their lazy brains don’t have to connect those dots if I do it for them at the outset.

As nifty as it is to think about how even a “because” followed by nonsense activates certain patterns of compliant activity in a brain, that’s a pretty low rung on the ladder of persuasion. Think, for instance, about a parent telling a kid to clean up their room “because I said so” as compared with “because we have company coming over, and it’s embarrassing for them to see a mess.”

Higher rungs on that ladder would include offering “becauses” that:

• Make logical sense
• Are as simple and directly related to the request as possible
• Jibe with already-held beliefs, interests, or goals of the target audience
• Are sincerely believed by the person offering the “because”

I’d suggest making a special effort to keep that last one in mind. No, mind-reading isn’t a thing, and if the “because” you offer is really a lie, you might get away with it…but some things just have a ring of truth (or falsehood) to them. Also, people might remember things you’ve previously said or done that your “because” now contradicts. Or, something you say/do in the future will clash with it.

If, on the other hand, people come to know and trust that the reasons you give them are the real deal, “becauses” from you will come to have a strong track-record. Strong enough, perhaps, that even when you don’t use that magic word, the folks around you will respond as if you had.

Follow Editorial Board member, Eric Postal, M.D., on Twitter, @EricPostal_MD.