The EQ dream

The whole idea of IQ is poison to the "all men are equal" crowd because it demonstrates that they are not. So the game is on to show that IQ differences may exist but those differences are unimportant. And the prime way of doing that has been to promote the idea of Emotional Intelligence (EQ), which can be trained.  In any activity taking part among a group EQ is said to be very important.  It's an attractive dream but it is at variance with reality.  Because it is so attractive it has been much researched and the Wikipedia entry on it summarizes the findings pretty well.

Chief among the problems with EQ, is that there are a variety of things which are called Emotional Intelligence but they correlate poorly with one another  So which is the "true" emotional intelligence?  The concept is fine but going out there among the population and assessing it is very difficult.  One could argue that if it can be measured, nobody so far has achieved that.  Different tests will pick out different groups of people as emotionally intelligent.  Does it exist at all in reality?

The second problem is predictive power.  No matter which version of EQ that you use does it predict success (however defined) any better than IQ?  And it does not in general.  All the enthusiasm for it is misplaced.  It is a unicorn concept.  It sounds attractive but it does not exist out there in the world.

So why on earth is Ezekiel Emanuel pushing that old barrow of rubbish below? Easy. He is a far Leftist and the chief architect of Obamacare. His brother is Chicago Mayor Rahm Emanuel. His ideology makes him WANT to believe in EQ. The editors of JAMA were very incautious to let his blatherings into the pages of their journal. Obviously, they knew nothing about the psychological research into EQ

Does Medicine Overemphasize IQ?

Ezekiel J. Emanuel, MD, PhD; Emily Gudbranson, BA

Everyone wants the best physician. Patients want their physician to know medical information by heart, to possess diagnostic acumen, and to be well-versed in the latest tests and treatments. Finding the best physicians often involves looking for resumes with stellar attributes, such as having graduated at the top of a collegiate class, attended the best medical schools, completed internships and residency training at the nation’s most prestigious hospitals, and been awarded the most competitive fellowships. Many medical schools, likewise, want only the smartest students, as assessed by the highest grade point averages and MCAT scores.

This selection process has persisted for decades. But is it misguided? Do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?

Overemphasizing IQ

By prioritizing academic pedigree, the medical profession has traditionally overemphasized general intelligence and underemphasized—if not totally ignored—emotional intelligence. With “objective” assessments and little grade inflation, performance in hard science courses and on the MCAT have been the primary determinants of medical school admissions.1,2 Although good test scores and grades in calculus, physics, or organic chemistry may signal one kind of intelligence, reliance solely on those metrics results in an incomplete and inaccurate assessment of a student’s potential to be an excellent, caring physician.

Medical schools often conflate high MCAT scores and grades in the hard sciences with actual intelligence. For instance, good test takers can score extremely high on multiple-choice examinations but may lack real analytic ability, problem-solving skills, and common sense. Scoring well on these metrics reveals nothing about other types of intelligences, especially emotional intelligence, that are critical to being an excellent physician. Knowing how to calculate the speed of a ball rolling down an inclined plane or recalling the Bamford-Stevens reaction are totally irrelevant to being an astute diagnostician, much less an oncologist sensitively discussing end-of-life care preferences with a patient who has developed metastatic cancer.

The prioritization of student grades and test scores in the US News & World Report rankings of medical schools fuels a vicious cycle. Medical schools have placed more emphasis on these criteria, ultimately striving to select students with higher scores to maintain their ranking. From 2000 to 2016, the grade point averages of students admitted to US medical schools have actually increased from 3.60 to 3.70,3 and MCAT scores in both biological and physical sciences have also increased by 5% to 10%.4 European universities may emphasize IQ even more in medical student selection, because they rely on standardized tests at the end of high school, such as A-level examinations in England.

Providing high-quality care certainly requires intelligence. A high IQ may help a physician diagnose congestive heart failure and select the right medications and interventions, but it is still no guarantee that the physician can lead a multidisciplinary team or effectively help patients change their behaviors in ways that tangibly improve their health outcomes.

The Ubiquitous Importance of Emotional Intelligence
A certain threshold of intelligence is absolutely necessary to succeed in any field. In medicine, IQ is necessary to master and critically assess the volume and complexity of information integral to contemporary medical education. But past this threshold, success in medicine is ultimately more about emotional intelligence.

Psychologists have identified 9 distinct kinds of intelligence, ranging from mathematical and linguistic to musical and the capacity to observe and understand the natural world.5 Emotional intelligence (EQ) is the ability to manage emotions and interact effectively with others. People with high EQs are sensitive to the moods and temperaments of others, display empathy, and appreciate multiple perspectives when approaching situations.

Is EQ really necessary for success? A major part of what distinguishes human brain functions from those of primates is a larger prefrontal cortex and extensive intrabrain connections, which endow humans with significantly greater ability to navigate social interactions and collaborate. It makes sense, then, that humans should use this unique ability to its greatest extent.

Consider a simple negotiation session. Participants—executives, physicians, and others—are grouped into teams and given the exact same starting scenario and facts. When told to come to the best possible deal, as measured in a hard outcome such as the most money, results vary 4-fold or more. The best deals are reached by teams that exhibit mutual trust, an understanding of the interests of the other side, and the ability to reach a mutually beneficial arrangement. These variations are not the result of differences in brain power but rather differences in EQ. According to Diamond, “[In negotiations] emotions and perceptions are far more important than power and logic in dealing with others. [EQ] produces four times as much value as conventional tools like leverage and ‘win-win’ because (a) you have a better starting point for persuasion, (b) people are more willing to do things for you when you value them, no matter who they are, and (c) the world is mostly about emotions, not the logic of ‘win-win.’”6

EQ in Medicine

Vitally important to the success of 21st-century clinicians are 3 capabilities: to (1) effectively lead teams, (2) coordinate care, and (3) engender behavior change in patients and colleagues. (Both 1 and 3 require negotiating skills.) Thus, effective physicians need both an adequate IQ and a high EQ.

For the 10% of chronically ill patients who consume nearly two-thirds of all health care spending,7 the primary challenge is not solving diagnostic conundrums, unraveling complex genetic mutations, or administering specially designed therapeutic regimens. Rather, physicians caring for chronically ill patients with several comorbidities must lead multidisciplinary teams that emphasize educating patients, ensuring medication adherence, diagnosing and treating concomitant mental health issues, anticipating potential illness exacerbations, and explicitly discussing treatment preferences.

These activities depend on listening, building trust, empathy, and delineating mutual goals. Chronic care management, in addition to sufficient intelligence, therefore primarily requires a high EQ. As Goleman suggested, “Analytics and technical skills do matter, but mainly as ‘threshold capabilities’—that is, they are the entry-level requirements for executive positions… [But] emotional intelligence is the sine qua non of leadership. Without it a person can have the best training in the world; an incisive analytical mind; and an endless supply of smart ideas; but he still won’t make a great leader.”8

Minimizing or ignoring EQ when selecting and training medical students may partially explain why US medical professionals fare so poorly in assembling well-functioning teams to care for chronically and terminally ill patients.


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