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RobinZ comments on Open Thread: May 2010, Part 2 - Less Wrong
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Morendil:
One relevant difference is that the medical profession is at liberty to self-regulate more than probably any other, which is itself an artifact of their status. Observe how e.g. truckers are rigorously regulated because it's perceived as dangerous if they drive tired and sleep-deprived, but patients are routinely treated by medical residents working under the regime of 100+ hour weeks and 36-hour shifts.
Even the recent initiatives for regulatory limits on the residents' work hours are presented as a measure that the medical profession has gracefully decided to undertake in its wisdom and benevolence -- not by any means as an external government imposition to eradicate harmful misbehavior, which is the way politicians normally talk about regulation. (Just remember how they speak when regulation of e.g. oil or finance industries is in order.)
The reason I attach high plausibility to such explanations is simply that status is the primary preoccupation of humans as soon as their barest physical subsistence needs are met. Whenever you see humans doing something without an immediate instrumental purpose, there is a very high chance that it's a status-oriented behavior, or at least behavior aimed at satisfying some urge that originally evolved as instrumental to human status games.
The alternatives you mentioned are by no means incompatible with status-based explanations, and some of them are in fact reducible to it. For example, the behavior of doctors in TV shows is a reflection of the whole complex of popular beliefs and attitudes from which the medical profession draws its extraordinary status -- and which in turn shapes these beliefs and attitudes to some extent. So, as I wrote in one of my other comments, if doctor TV shows started showing cool-looking checklist rituals prior to the characters' heroic exploits, these rituals would probably develop a prestigious image, like countdown procedures in action movies, which would likely facilitate their adoption in practice.
In the spirit of Morendil's question: what other professions should be shunning useful but low-status tools (particularly checklists) for the same reason as doctors, according to the status model? I don't know enough about (a) lawyers, (b) politicians, (c) businesspeople, (d) salespeople, or (e) other high status professions to judge either what your model would predict or what they do.
It's worth noting that engineering is (moderately-)high-status but involves risk of personal cost in case of error, making the fact that it shows widespread adherence to restrictive professional standards explicable under the status theory.
Now that's an interesting question! Off the top of my head, some occupations where I'd expect that status considerations interfere with the adoption of effective procedures would be:
Judges -- ultra-high status, near-zero discipline for incompetence.
Teaching, at all levels -- unrealistically high status (assuming you subscribe to the cynical theories about education being mostly a wasteful signaling effort), fairly weak control for competence, lacking even clear benchmarks of success.
Research in dubious areas -- similarly, high status coupled with weak incentives for producing sound work instead of junk science.
For example, there are research areas where statistical methods are used to reach "scientific" conclusions by researchers with august academic titles who are however completely stumped by the finer points of statistical inference. In some such areas, hiring a math B.A. to perform a list of routine checks for gross errors in statistics and logic would probably prevent the publication of more junk science than their entire peer review system. Yet I think status considerations would probably conspire against such a solution in many instances.
I disagree somewhat that judges face near-zero discipline for incompetence. Except for judges on the highest court in a jurisdiction, most judges frequently face the prospect that the opinions they author may be reversed. It is true that frequent reversals will almost never lead to the sanction of the judge losing his or her job (due to lifetime appointments or ineffectiveness of elections at removing incumbent judges except for the most serious and publicized faults). But the resulting hit to status for frequent reversals can be quite serious; and because judges are so high status, as you note, they tend to be very concerned with maintaining that status. The handful of judges I've known personally have been quite concerned with their reversal rate and they particularly don't want to be reversed in a way that is embarrassing to them because it suggests laziness, incompetence, poor reasoning, cutting corners, or the like. (On the other hand, reversal for disagreements that can be characterized as “political” is probably not seen as quite so status-lowering.) At any rate, the law does provide checklist-like procedures or guidelines in many instances, and most judges do follow them, at least in part because failure to do so could lead to reversal.
Expanding on your example of judges- this fits in with general problems for people in the legal professions. For example, there have now been for many years pretty decent understanding about problems with the standard line-up system for criminal suspects. There are also easy fixes for those problems. Yet very few places have implemented them. Similarly, there have been serious problems with police and judges acting against people who try to videotape their interactions with police. Discussing this in too much detail may however run into the standard mind-killing subject.