Introduction

We often sort people, including ourselves, into categories. These categories can be defined along myriad lines to include one’s external appearance, cultural/religious affiliation, level of education, educational institution, and self-described traits or interests (foodies, musicians, physicians etc.) among others.  Such categorization is closely tied to the anthropologic concept of tribalism. Tribalism refers to the organization of people into groups based on the possession of a shared identity that is distinct from the identity of members who are not part of that “tribe.”

At its core, tribalism is founded on the concept of  Us vs. Them.  As Berreby points out in his book, Us and Them: The Science of Identity, humans have a strong tendency to categorize others, especially strangers, and to use that categorization to decide how to interact with them.  Historically, such categorization may have offered safety – allowing us to rapidly identify “outside threats” while offering a sense of comfort from feeling included as part of a group that offered mutual protection.

The cost of this safety, however, is isolation which can limit our progress and growth, and impede our ability to productively engage with others.   While one may presume that categorization and tribalism are only an ancient phenomena, this is not the case.  Examples of such categories and tribes in our everyday lives include: Army and Navy; doctors and nurses; patients and providers; well-educated and poorly-educated; atheists and believers;  black and white… and the list goes on.

In the healthcare world, such categorization and tribalism has significant implications for patient care. Thinking about others as us or them fundamentally requires us to make assumptions that may or may not be true. Such assumptions can impede our ability to effectively communicate with others, deprive us of meaningful relationships, contribute to workplace stress, and ultimately, negatively affect patient care.  Fortunately, examining our own propensity for thinking in an Us-Them construct offers us the opportunity to identify our own assumptions and realize the benefits that often come from redefining “others” as “fellow human beings.”

Assignment

Prior to the small group session:

• watch the talk by Dr. Victoria Brazil and read the accompanying article on EmergencyPedia
• read/watch one or more of the additional resources

Come to the small group session with notes that answer the following questions:

1. In what areas of your personal life do you consciously or subconsciously experience the Us-Them phenomenon?  Come prepared to discuss specific examples and address the following items:
   1. What are the positive and negative implications of thinking in terms of Us-Them?
   2. What are some potential biases that this Us-Them scenario creates in the way that you think about yourself and the way that you think about others?
2. In what ways have you experienced tribalism and/or the Us – Them phenomenon growing up in your family of origin? As you think about this, identify a specific situation that you have been involved in and be prepared to describe the situation to the group and discuss the following:
   1. Who was “us” and who was “them?”
   2. What were your assumptions about how “they” think that is different from the way “we” think?
   3. How did this affect your relationship with “them?”
   4. How might a similar situation affect your job/workplace stress and satisfaction?
   5. How might a similar situation impact patient care in your future role as a medical student/physician?