Today, my dentist found a possible oral cancer.

I'm 31, a non-smoker, in good health. I know the research showing that doctors ignore base rates and overestimate your chances of cancer. (I asked the doctor the base rate, he didn't know.) I know that we grossly overprescribe biopsies and surgeries, when it would be better to just wait and see. But I'm having it removed and biopsied on Friday, even though I don't have dental insurance and it's costing me $1,000 of my own money.

Why?

I thought this would be an interesting case study: Introspectively, what's going on to make me ignore my rationalist training, ignore the external data, and choose what I know is probably the less optimal path?

My first thought is embarrassment: If I do nothing, and it turns out I have cancer, will my support network roll their eyes and blame me for not being more aggressive? My feeling is yes, that even though they wouldn't do it to my face, they would secretly blame me, and become less available.

My second thought is fear of the unknown: I roughly know what the biopsy will entail. It's a light anesthesia, a few stitches, and 1-2 days of recovery. No big deal. And $1,000 isn't tiny, but it's not a big deal for me, either. In contrast, what happens if I don't do the biopsy? Huge, scary unknown. And, even if I know that I only have a 0.01% chance of having cancer (to guess a number), I also know my emotional mind is bad at math, and I'll have great difficulty controlling its worry. And so, it's rational to buy some level of anti-worry insurance -- I don't know what the rational value of that anti-worry insurance is, and I don't know if that value exceeds $1,000, but clearly, anti-worry insurance has some positive value, and probably a fairly high value.

There are other considerations. I need some wisdom teeth removed, and we're doing them at the same time, so adding the biopsy doesn't affect the recovery time. And I have a 6-week trip to Australia coming up, and I'd hate to have problems while I'm traveling. But mostly, I think it's embarrassment and worry.

By the way, this is a personal matter than I'm choosing to share with you. Honest advice about how to handle it, particularly from people who've faced similar decisions, is welcome and appreciated. Flames about how I'm ignoring research are not. Thanks for understanding.

Update: I talked with a friend who does research in medical decision making. She explained that, for the specific population a doctor serves, he's usually fairly accurate in his estimates of how prevalent a disease is. She also encouraged me that I'm right to get the biopsy. I feel much more relaxed, and I realized that I was feeling guilty about being irrational. I'm sure there's some meta-lesson in there that I'll figure out someday.

"Having been that monologuist, I fully endorse this article." -David Gerard

This is part of a series on leading discussions, aimed at teachers and event organizers.

Have you ever been in a discussion (in a class or a workshop) when another attendee delivered a monolog? It lasts for several minutes, drains the energy from the group, and gets the whole event off schedule.

As the meetup / workshop / class leader, it's your responsibility to address these time monopolizers and keep everything moving. This article will give you some tips on identifying when you should intervene, and on how to intervene politely.

Identifying Time Monopolizers

If one person is talking for an extended period, they are probably monopolizing the conversation. Here are some specific signs to look out for:

• The person has covered multiple topics without anyone else speaking. If they are moving from topic to topic without other people chiming in, it's a monolog, not a discussion.
• You (the leader) feel bored or annoyed. Most of the time, everyone else will feel it 10x as much, because they are already less engaged in the conversation than you are. Tip: Don't wait until you're going to snap. Instead, as soon as you notice yourself getting bored / annoyed, shut the monolog down. (Note: I mean "annoyed they are taking up so much time," not "annoyed they disagree with me.")
• Other attendees are disengaged. This often manifests in reading handouts or emails, looking out the window or down at their hands, and otherwise not paying attention to the speaker.

If only one of these items is true -- if the person is crossing multiple topics, but you and the class are engaged, for example -- then feel free to let them speak. But if two or more of these items are true, you should probably intervene. (See the next section for how to do that.)

If the event ends and you're not sure if someone was monopolizing the conversation, ask the quiet people how it went, and ask them if anyone in the group slowed the class down or monopolized the conversation. They might be too polite to bring the issue up, but once you ask directly, they'll let you know what's going on. Make sure to thank them for their honesty, and keep their feedback anonymous when you talk to the time monopolizer.

One note: While a monolog that covers multiple topics is usually bad, a discussion where multiple people cover multiple topics is usually good, even if it prevents you (the leader) from hitting all the topics you'd planned for the event. After all, most people show up at events to meet like-minded people and make new friends, not to cover each of the items on the handout.

But, do pay attention to the rest of the attendees: Are they engaged or checked out? Is this a discussion involving half the group, or a dialog between only two people? As the leader, are you interested in the discussion? If two people are having a dialog, and the rest of the group is checking out, it's your job to shut that dialog down, too.

How to Intervene

Politely. This is the key. As the leader of the event, any reprimand you give will be felt more deeply than a reprimand given by a peer.

Wait for the person to take a breath, then speak up. (If you don't get that chance after 20 seconds or so, raise your hand like you're stopping traffic, wait a second, then start speaking.) Say something like:

That's really interesting. I'm just going to pause you for a second so we can get back to the topic. Grab me afterward and we can discuss that some more.

Note that we started with praise ("That's really interesting.") Don't worry, they'll get the message. Then, without saying anything negative about the person or his statements, simply say that you need to get back on topic.

Also, avoid saying "but" here: "That's really interesting, but I'm going to pause you…" The "but" construction negates the first sentence, and could make it sound sarcastic.

Here are some other phrases you can try:

• That's really interesting. I'd like to hear from some of the other folks. (Then ask someone else what they think.)
• I'd love to explore this more with you offline. Could you grab me after (the class / workshop / whatever event this is)?

[Note: Please add to this list.]

What if you don't stop a monolog during the event, but realize afterward that you should have? That's just fine. The point isn't to have every event run perfectly, but rather, to make sure that no one repeatedly monopolizes the conversation month after month. Just talk to them afterward, and say something like:

I noticed you were speaking a lot during the event. I love how passionate you are about these topics. I have a favor, though: Some of the people are a little more shy and reserved than you are, and I want to make sure everyone gets a chance to speak. After all, if there are 10 people here, then ideally, each person would make about 10% of the remarks. Do you think you could talk a little less at the next meetup, to give everyone else more of a chance?

(Note: It's not actually important that everyone speak for the same amount of time, but it's a good way to explain what isn't working. Feel free to use your own judgement on how to help your particular time monopolizer understand what's not working.)

In all these interactions, make sure to smile and be friendly. Remember, he probably doesn't realize he was monopolizing the conversation. And keep in mind that no one adjusts instantly, and you might still need to jump in and direct the conversation at the next event, too.