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Help! A Patient took it! (Understanding the Genetics of Generosity)

Thou hast stolen both mine office and my name; The one ne'er got me credit, the other mickle blame~ William Shakespeare

At my skin clinic, since 1996 we have offered skin cancer checks. We never bothered with government grants or billing insurers. It was a community service given the high rate of skin cancer down under – with a view to picking up life-threatening skin cancers and treating them early.

A few years ago, when we reviewed our audits (more to determine the prevalence of non-melanoma skin cancer in the community, given the government departments don’t bother collecting data except for melanomas), we realised we had seen over 100,000 patients at no cost. Based on the average fee for such a service, we had saved the health system between 15-30 million dollars!

About 6 months ago we introduced a nominal $40 fee for these checks (except on Wednesdays, when the service is still pro bono). It was still a fraction of what the usual fee for such a skin cancer examination is anywhere else. It was interesting to note the responses from patients. Most told me, “It was about time! Someone with an international reputation as a skin cancer expert should not be undervaluing yourself.”

Some complained (not to me, but people abuse my poor reception staff) at having to pay for such a service after having had it at no cost for all these years! We also noted that most people ringing up for a free consultation on a Wednesday these days are young executives or people in better-paying jobs. For me as a writer, where I am truly humbled to have the daily narrative of patients it was a merely interesting observation about human nature. Until yesterday …

On Wednesday, I spent all day seeing patients. Didn’t break for lunch. No billing. Popped in and out of the room to check on patients in other rooms, or in and out of the OR. My laptop and iPhone were on my desk as always. At the end of the day, I noticed my phone was gone! I could not believe it could have been possibly stolen by a patient, and therefore I turned the place upside down and inside out and found nothing. I rang my telecommunications service provider.

They told me that it had pinged a cell-phone tower a few miles down the road from me before it was turned off at 2.58 PM. Every patient before 2.58 was a suspect as other than patients and I no one had entered my room! The police asked me to provide a list of each one. I declined citing patient confidentiality as there was no public danger at stake, and I felt I should not spoil my equilibrium or change my practice. Was I being foolish or naïve? Possibly.

The most annoying thing is – everyone now makes me feel like a mug! The insurer said: “Why’d you leave your phone unattended with a patient in the room in the first place” – The police also suggested, “It’s not good practice is it, to leave things unattended?!”

The truth is I didn’t expect this. It was my own personal consulting space. I’ve always treated patients like my family. Even with the evidence from the telecom provider, I still spent Thursday searching the place, willing them to be wrong. When I mentioned this to another patient she said, I am surprised you are still smiling.”

Truth is, ultimately it is more about me. I don’t want to see a patient and perform a life-saving procedure, and even consider that they have any malice towards me. Philosophically I’ve often said that the best method is to treat patients like family. And I do.

But that got me thinking. In my book The Genetics of Health, I talk about the “generosity gene” being a double -edged sword. As I wrote in the book, when volunteers placed the interests of others before their own, the generosity activated a primitive part of the brain that usually lights up in response to food or sex—the prefrontal cortex. Donating to others made the brain’s two reward systems work together: the midbrain ventral tegmental area (VTA), which is stimulated by food, sex, drugs, and money -- and the subgenual area, which is stimulated when humans see babies and their romantic partners.

These traits are for our own good; not only does this mean we help others, but there is also generally lower health risk in being addicted to generosity in comparison to alcohol or sex—in my years as a physician, no one has been admitted to the hospital for suffering from acute generosity! I myself have never been admitted to hospital or fallen ill in my 30 years as a doctor (fingers-crossed …hope this record stands until my next blog!), so perhaps giving is better than taking.

In a study,nearly half the people who were more giving were in excellent health (48 percent), as opposed to only one-third of the “ungenerous” (31 percent). In other words, there is a reason that the traits of giving and generosity are important for human survival, and our genes are merely facilitators. We know that people who have certain variants of a gene called AVPR1a give, on average, nearly 50 percent more money than those who do not have it. But given these genetic findings, miserliness only leads to misery, or ill health.

For me it more a nuisance that it’s taking 2 days to replace a phone and I worry I am missing important calls from patients. And given I didn’t always backup my photos, I’ve lost a few valuable ones. I’ve learnt a lesson there! To the person who’s taken my phone (and it could not have been accidental as was on my desk) they will have no need or respect for those images. I am still hoping someone would quietly drop it back in my letterbox.

I’ve said in other interviews: “Genes are our blueprint, not our destiny.” The AVPR1a gene is a double-edged sword as most genes are – one variant makes you generous, the other the opposite. Such is the science of anything – a double-edged sword. So the “nature” (gene) that makes us give (when “nurture” is lacking) can also make us take.

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