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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Lost in Translation

Translation (trăns-lā’shən) n.
  1. A restating of something in other, especially simpler, words.
  2. The act or process of translating, especially from one language into another.
  3. The process or result of changing from one appearance, state, or phase to another.

Last summer I had the opportunity to read the well known and highly regarded Tipping Point. Before bashing me for not being on the forefront of breaking business literature (published in 2000), remember that I am a recovering entrepreneur who had no time for such self-renewing, thought-provoking reads in the recent past. Several key themes immediately jumped out at me (and most have been commented on by others including here or here), but a recent event reminded me of a particularly relevant thought given my interest in open source and healthcare.

The Tipping Point is about the study of epidemics; not just the traditional disease epidemics but of social epidemics (like fashion fads, crime waves, copycat crimes, etc) and the factors that cause them to be explosive and exponential in their reach. An interesting supporting analogy to highlight the three-fold epidemic elements (which are the focal point of the book), was to understand the specific role of “translation“.

Translation is the ability to take a widely disparate set of information and put it into a framework that is understandable, predictable, and actionable by a large number of people. The ability to translate new trends of thought, fashion, or crime is a special gift of a specific group of people who can not only understand the innovators or innovations, but can also coherently and convincingly communicate this information to the masses. Interestingly enough, the concepts around translation have been studied in the context of understanding the power of rumors. In his book, ”The Psychology of Rumors”, sociologist Gordon Allport shares an interesting story regarding translation:

‘ ‘A Chinese teacher who was traveling through Maine on vacation in the summer of 1945, shortly before Japan’s surrender to the Allies at the end of the World Ward II. The teacher was carrying a guidebook, which said that a splendid view of the surrounding countryside could be seen from a certain local hilltop, and he stopped in a small town to ask directions. From that innocent request, a rumor quickly spread: a Japanese spy had gone up the hill to take pictures of the region. ‘The simple, unadorned facts that constitute the ‘kernel of truth’ in this rumor,’ Allport writes, ‘were from the outset distorted in…three directions.’ First of all the story was leveled. All kinds of details that are essential for understanding the true meaning of the incident were left out. There was no mention, Allport points out, of “the courteous and timid approach of the visitor to the native of whom he inquired; the fact that the visitor’s precise nationality was unknown,…the fact that the visitor had allowed himself to be readily identified by people along the way.” Then the story was sharpened. The details that remained were made more specific. A man became a spy. Someone who looked Asian became Japanese. Sightseeing became espionage. The guidebook in the teacher’s hand became a camera. Finally, a process of assimilation took place: the story was changed so it made more sense to those spreading the rumor. ‘A Chinese teacher on a holiday was a concept that could not arise in the minds of most farmers, for they did not know that some America university’s employ Chinese scholars on their staffs and that these scholars, like other teachers, area entitled to summer holidays,’ Allport writes. ‘The novel situation was perforce assimilated in terms of the most available.’ And what were those frames of reference? In 1945, in rural Maine, at a time when virtually every family had a son or relative involved in the war effort, the only way to make sense of a story like that was to fit it into the context of the war. Thus did Asian become Japanese, guidebook become camera, and sightseeing become espionage.’ “

” ‘Psychologist have said that this process of distortion is nearly universal in the spread of rumors. Memory experiments have been done in which subjects are given a story to read or a picture to look at and then asked to return, at intervals of several months, and reproduce what they had been shown. Invariably, significant leveling occurs. All but a few details are dropped. But certain details are also, simultaneously, sharpened. In one classic example, subjects were given a drawing of a hexagon bisected by three lines with seven equal-sized circles super-imposed on top of it. What one typical subject remembered , several months later, was a square bisected by two lines with 38 small circles arrayed around the fringes of the diagram. ‘There was a marked tendency for any picture or story [assimilation] to gravitate in memory toward what was familiar to the subject in his own life , consonant with his own culture, and above all, to what had some special emotional significance for him,’ Allport writes. ‘In their effort after meaning, the subjects would condense or fill in so as to achieve a better ‘Gestalt,’ a better closure – a simpler, more significant configuration.’ ”

” ‘In the case of the Chinese scholar’s vacation, the facts of the situation didn’t make sense to the people of the town; so they came up with an interpretation that did make sense – that the scholar was a spy – and, to make that new interpretation work, Allport identified that, ‘discordant details were ”’leveled”’ out, incidents were ”’sharpened”’ to fit the chosen theme, and the episode as a whole was ”’assimilated”’ to the pre-existing structure of feeling and thought characteristic of the members of the group among whom the rumor spread.’ ”

This act of translation can be a double edged sword – the message can be translated incorrectly (as in the case of the Chinese Scholar) to create fear, uncertainty, or doubt (FUD); or it can be translated correctly to create new insight, perspective, and actionable information for change. Open Source communities are particularly adapt at ensuring an accurate translation – or more succinctly – quickly cutting through to the “kernel of truth” to evaluate its contents and veracity. The transparent nature of these communities, the lack of proprietary walls to hide flaws, and the general meritocracy of ideas creates an environment for the truth to find its rightful way to the surface. This power of transparency is the enabling force of accurate translation that catalyzes the search for truth.

Because in the psychology of Open Source, and in the new culture of healthcare transparency, accurate translation quickly dispels the FUD grist that so often is a byproduct of the rumor mill.

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