INBW39: The Narcissism of Small Differences Is a Really Must-Know Concept When Attempting to Fix the Healthcare Industry

For a full transcript of this episode, click here.

This inbetweenisode is me geeking out, so if that’s not your thing, you’ve been warned.

There’s a term I’d like to encourage anyone interested to look up. It’s the narcissism of small differences. It explains a lot. The narcissism of small differences is the idea that those who, maybe in theory, should be friends/BFFs working side by side toward the same major goal are not. We divide ourselves into these micro-camps. Why? It’s a thing to get really narcissistic about small differences.

Consider vegans and vegetarians who are so often all up in each other’s business in really nasty ways. Who knew whether or not someone decides to eat cheese could create such enmity? Or there’s subreddits on Reddit dedicated to people fighting about fantasy football. You would think that everyone who plays fantasy football would be friends, except … not. There are apparently major schisms in the fantasy football world. Or consider branches of the same religion who are at war with one another. Consider people in the same political party fracturing over who is the very most whatever … pick something.

So, now let’s talk about the narcissism of small differences and how it’s relevant when we’re thinking about helping patients in the United States get better healthcare for an affordable price. We have these gigantic corporate entities right now very industriously vertically integrating to control supply chains and cornering markets buying up physician practices and using every trick in the book to extract maximum profitability from patients and taxpayers and employers.

Achieving some kind of tipping point where these incredibly well-orchestrated and well-funded profit machines are driven back will only happen when enough people, individuals, amass behind that tipping point. It will take more than a village. And my ardent request here is to—I don’t know—we quit it with the narcissism of small differences. Do not succumb.

“When you cling to ‘my way’ you preclude your ability to synthesize, cooperate, support, or even—in [some] extreme cases—peacefully co-exist with other members of your tribe. You destroy a fundamental reason for belonging in the first place: community.” That last bit was a quote from a blog post by Frances Cole Jones.

I love the community who I interact with most on LinkedIn, and there’s also some Listservs and some Slack groups that I love. Even X and Threads, for the most part, are lovely nests of great people trying to understand one another and further a common cause. I guess when you get into the kind of wonky stuff that you and I get into, there’s a finite group of us who are even reading these Tweets or posts or whatever they are. It’s a “small junior high school,” as one of my clients used to call it a long time ago.

But there’s also often enough that somebody who swoops down and in the name of ... something … slams a 95% aligned cause. It’s like two people agreeing on the restaurant to go to lunch, but one wants to go there and get a rice dish or because it’s closer to their house and the other wants to go there because the restaurant serves a great tortilla—and the two of them fight over what’s the right reason to go to that restaurant or what the best item is on the menu. This is literally a metaphor that describes some of the sniping that I have seen, that you have seen amongst mostly aligned folks trying to figure out how to put patients over profits. I mean, guys, go to the restaurant. Once you’re there, you can place separate orders. Work together to just get to the restaurant.

It's certainly easier to say than do, but if we’re aware of this and we focus on the points of agreement and maybe just think a little bit about whether the points of difference really even matter—in real life, not theoretical philosophy life—because a lot of times, they don’t. And then divided we fall.

I think a lot about small difference narcissism-ing when someone comments derisively that a post or an article puts too much emphasis on … I don’t know, transparency or employers or mental health or … pick something. But here’