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Deliberate accountability has arrived in the medical arena, producing an age of reward for measured performance and belief in publicising metrics to ensure clarity, with winning defined as hitting targets, whereby staff are incentivised by arbitrary objectives. Finite game theory declares that players are known, rules are fixed and the objective agreed upon, but infinite game theory asserts that players are both known and unknown, rules are changeable, and the objective is to perpetuate the game; these standards are clearly at odds and risk real-world chaos in global universal medical education and clinical outcomes and functioning. Five principles are necessary to lead an infinite game: first, a fair basis, such that sacrifices for its advancement are promoted; second, a trusting blame-free team culture and environment; third, competitors viewed as worthy rivals rather than adversaries, promoting healthy competition; fourth, existential flexibility when faced with credible evidence; and finally, transformational leadership, including infinite game theory into healthcare planning, may be difficult, but the potential rewards are surely worth the existential fight.
Nowhere have the virtues of competition, performance metrics and precision been more touted than in the arena of medicine, understandably so, because stakes are seldom higher, for lives are on the line.1 Winners and losers emerge, because if there are at least two parties involved, each with different perspectives, then a game is in play.
Game theory is divided: finite and infinite.2 Finite games are played by known players, have fixed rules, and agreed upon objectives that, when reached, end the game. Rugby for example, is a finite game. Players wear identifiable uniforms; there are agreed upon rules, which referees are present to enforce. All agree to play by those rules, accept penalties if broken, and whichever team has scored more points, by a set time, will …
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Contributors AGP: conceptualisation, planning and writing (first draft and revision, submitted manuscript). CBo: writing (first draft and revision). CBr and RJE: planning and writing (revision). WGL: conceptualisation, planning, writing (first draft and revisions).
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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