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Population Mentality: Core Driving Forces of Maintaining Status Quo Versus Change.

Mob mentality and crowd mentality are two population mentality descriptions in common use. Crowd mentality generally is emotion neutral and reflects when a group of individuals see a common purpose, whereas when mob mentality is used, it reflects a similar effect with a more sinister agenda.

At the core of two large population mindsets is the perceived importance of maintaining a status quo versus seeking change. As with everything at a population, individual, and cellular level there are always competing forces, and in a population setting competing narratives that are often quite opposed. Conflicting narratives we all possess. So although a core may exist, there are many components and a number of them are competing. Again, although we may not understand them all, we do have to accept they exist. This is true in medicine (and ofcourse the cellular forces in GDD... yes of course I had to mention it{ when all you have is a hammer everything looks like nails, and in some fashion that also can be true). A present-day example of competing narratives that wise, critical thinking individuals deal with (atleast in an individual perception basis) is what Hamas did to the Israeli population (which included foreign nationals) is horrific on a scale we associate with Nazis, essentially nothing is more evil. At the same time what is happening to the Palestinian population in Gaza is enormously tragic... Both narratives are true.

Maintaining status quo, itself is a complex subject. It most often is not a true status quo, but a perceived status quo, that is often nostalgic and also imaginary. Politicians often play off the population's perception of preservation of the nostalgic status quo. This driver is generally fear-based, and mainly represents fear of the unknown. There is also a sentimental status quo, also called Golden Age thinking, which I am also given to. This itself in often imaginary and self-focused. For me, the period from 1993 - 2000 as the director of MR Services at UNC Chapel Hill and the undisputed world champion of abdominal MRI, who everyone in the field around the world at the time revered. Gradually more radiologists at other major centers established expertize. Golden Age thinking, including the aspect of being a privileged white male perspective.

Change as a driving population force carries with it the concept of beneficial to people in a largest sense. Quite often though change is initiated as a concept that benefits the few interested in a certain change. This is a core tension in two current TV series that I am very fond of: the Gilded Age and Belgravia. Essentially the story-line also described in the Roaring Twenties Fitzgerald novel the Great Gatsby. The forces of status quo being the established money class versus the new money class trying to break into that privileged class. This has been the tension in human political forces perhaps for 1 million years. In antiquity a great example is the aristocracy tenants of Cornelius Sulla versus the modernization tenants of Gaius Marius, and the slaughter of each other's group when they were in power., Sulla first, Marius after. Julius Caesar arose as the disciple of Marius. Traditionally the concept of maintaining status quo is a mind set associated with aristocracy, and effecting change associated with accomplished people wanting to gain access to the privileged class.

Status quo is associated with overlapping circles of interest/thought, which are not identical: tribalism, conservatism and nationalism being the dominant overlapping circles.

Change is associated with the overlapping circles of altruism, liberalism, and globalism.

In US politics, perhaps two of the greatest presidents were Abraham Lincoln, founder of the Republican Party who abolished slavery as a champion of change; and Franklin D Roosevelt a Democrat who pushed for improved conditions for the lower income as a champion of change. Throughout the US History groups from both parties represented champions of change and retainers of the status quo. Generally, but not always, proponents of status quo have been the more abhorrent group.

The perception of where money can be made,, or atleast maintained, enters both of these population mentalities, where maintaining money is a major driving force in status quo and making new money a driving force in change. The tendency to benefit the population as a whole has greater presence in Change mentality than Status Quo mentality, but can exist in both.

False prophets abound in both spheres of thought. Perhaps more common in status quo mentality because fear is generally a more common feature in this mind set, and is an enormously powerful motivator in human behavior= perhaps the most important..

What makes all of this the more fascinating (as we also see at the cellular level in humans) is that there is often not a pure status quo or a pure change mindset. There is almost always a combination of both, and these narratives can also be competing and changing, and in a short time frame.

I will end by looking at Radiology as an example of the wider sphere of population mentality throughout all human and perhaps biological history. There is considerable interest in modernization in Radiology, and this is true of all of Medicine, particularly since the inception of strong science and reality-based thinking which gained dominant force in the mid nineteen hundreds (so around 1850). So many practitioners trying to be focused on improving patient care based on direct observation and also progressively more on science. A number may have had as their driving force to enrich themselves, but nonetheless the predominant driving force improving the health of people. There is currently enormous interest in Artificial Intelligence (AI). A large core of it centered on the improved ability to render accurate diagnosis and also with time benefit of shortening the lag time in making the diagnosis. All this at great benefit to patients. There is the other important component, and it is human nature in all of us, that this may make reading imaging studies look similar to cash counting machines in a Las Vegas casino, with $100 bills flying through the machines at an incredible clip.... This ofcourse is also what payers are looking at. So competing narratives. So AI will probably be a powerful modernization change agent.

At the same time, what I also find somewhat sad, but understandable, is the lack of awareness, or better said, willingness to be aware of the subject of GDD. How is it possible that radiologists are both very keen on the change concept of AI, but so resistant to wanting to understand about GDD? It is a very good example of having competing narratives in mind, as I described at the outset with the Israel-Hamas conflict. At the core of the mental conflict,  I believe, in the radiology is economics. Money as I said above enters into the thinking of Status Quo and Change above. AI carries the potential for great financial reward, but also, and I do not intend to downplay this driving force, the great potential to benefit patients' health. Regarding the concept of GDD, although safety is something radiologists believe they value, in my opinion it also elicits the primal fear of losing money, for maybe 50% it means less money for MR studies, both fewer MRIs and less added money from GBCA contrast, but for 80- 90% is the fear of being held legally responsible for an adverse outcome that the patient has experienced. Although many of these adverse outcomes are real, but a number may not be, and with an unsophisticated jury that currently exists in medical malpractice cases, truth is less important or successful, than the portrayal of the plaintiff (and the defence) - so emotions and not fact are the driving force. And emotions can result in $20 million settlements.

I consider myself as well informed, perhaps the most informed, of anyone regarding the full dynamics involved in the Story of GDD, and by extension probably safety in Radiology in general. For all stake holders on all sides: I get it. That is why I follow the middle road. And by the way, the only prospect of peace in that Middle East location is a two state solution. In Rome in the 3rd century AD (CE) once the government started paying 150,000 gold solidii annually to Goths, Visigoths, Huns not to kill them.... eventually they are going to come for all of it. Money buys only so much loyalty for so long. Like driving suitcases of cash to hand to people whose avowed goal is to kill you, won't work for long, especially if some of the intent is nefarious in order to sow division.

Richard Semelka, MD

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