When my doctor ordered a CT scan I didn’t need, I found myself in an uncomfortable position. As a physician myself, I quickly realized the scan was unnecessary and preferred not to expose myself to ionizing radiation, which can increase the risk for cancer. Nevertheless, I dutifully played the role of the compliant patient.
Saying no to bad advice sounds simple, but in reality it can be astonishingly difficult. No one wants to insinuate that our advisers, co-workers or leaders aren’t trustworthy — that they could be biased, corrupt, or just plain wrong. We would rather avoid the discomfort that comes from putting them or ourselves in an embarrassing position.
This instinct is pervasive and can lead us to make bad decisions, large and small, by following suggestions we don’t trust. For example, accepting unwise medical advice, following unethical directives at work, or paying for unnecessary “repairs” to your car. It motivates us to avoid embarrassment, be polite and help our adviser “save face.” It can be incredibly difficult — palpably unpleasant — to turn down even obviously wrong recommendations.
In a series of experiments, my colleagues and I had a middle-aged man offer 253 ferry passengers traveling from Connecticut to Long Island the choice between $5 and a chance in a mystery lottery (paying from $0 to $10 with an average payout of less than $5) in exchange for completing a short survey. When he gave no advice, only 8% of survey-takers chose the lottery. When he advised passengers to choose the lottery, 20% did.
More alarming were the results when he disclosed that, if they chose the lottery, he would receive a bonus: As logic suggests, the passengers told us they trusted him less now they knew about his conflict of interest. Yet, 42% of them complied and took the lottery. Why? Passengers said that, despite their mistrust, they felt uncomfortable rejecting the man’s advice because doing so would insinuate they believed he was biased because of his bonus. We call this feeling “insinuation anxiety.”
This type of acquiescence extends to actions that harm others, not just ourselves. The impulse to comply can make it very hard to stand up to people in authority, even when we know something is wrong. It’s why co-pilots are reluctant to speak up to their captains even when lives are in danger and why nurses don’t always raise concerns when surgeons make medical mistakes. It can also partly explain why women who are sexually harassed during job interviews do not take action in the moment, and why few people confront someone who utters a racial slur.
Insinuation anxiety can account for why a graduate student in MIT’s Media Lab who, despite her concerns, complied with orders from her adviser to send a gift to Jeffrey Epstein, the convicted sex offender, for donating to the lab. In Stanley Milgram’s famous psychology experiments, insinuation anxiety might help explain why two-thirds of participants were willing to administer what they believed to be dangerously strong electric shocks to a stranger. Many of the participants were visibly distressed, but after being told to continue, the majority did.
From such dangerous decisions to everyday acceptance of others’ preferences over our own, insinuation anxiety affects us all. Even civil rights icon Rosa Parks, famous for defiantly rejecting an order to relinquish her bus seat to a white passenger, confessed that she once was too timid to turn down the role of secretary (considered to be a woman’s job at that time) when asked by a civil rights organization. We can be so consumed by being polite, we forget to be ourselves.
There are sometimes good reasons to comply and keep harmony. Telling your boss they are wrong may certainly lead to negative consequences. But the danger of uncompromising acceptance is an accumulating cost to ourselves and others.
How can we improve our ability to reject advice that we don’t trust? Being informed is important, and planning ahead for what to do and say is crucial. Those who have agreeable dispositions or are conscientious — usually desirable traits in society — are more likely to conform to the requests of others and may need to work harder to reject advice.
Asking for more time before committing to a decision or requesting a “cooling off” period during which you can change your mind can help reduce the pressure to comply. Time to process the information in private is important because our strong desires to avoid implying impropriety — even in one-off interactions — can lead us to ignore our interests and harm ourselves or others.
After my experience with the unnecessary CT scan, I promised myself that the next time imaging was ordered, I would not only question why but also be more mindful to state my preference. A year later, I did just that when another doctor ordered an unwarranted X-ray for me. Refusing consent was difficult, but I stood by my preferences.
Sunita Sah is a professor of management and organizational psychology at Cornell University and a visiting scholar at the Russell Sage Foundation.