The Doctor Will Persuade You Now – May 2010

http://blogs.wsj.com/health/2010/05/10/the-doctor-will-persuade-you-now/
By Katherine Hobson Wall Street Journal Blog
If we were completely rational beings, decisions about our health and medical care would be much different. But as behavioral economics has shown, we often instead fall victim to certain biases and pitfalls that lead us to act against our own long-term goals — for instance we may smoke, even though we know it’s likely to shorten our lives, because we don’t actually know anyone who’s had lung cancer.
Doctors could better arm themselves to detect and counter those biases in their patients, according to a paper published in the Annals of Family Medicine. http://www.annfammed.org/cgi/reprint/8/3/260 (also attached below)
For example, we tend to be influenced by “what is most readily available in memory,” the paper says, which means “recent, rare and vivid events.” So, a 30-year-old woman at normal risk of developing breast cancer wants a mammogram because she just saw a wrenching Lifetime movie about a young woman with the disease. That’s called the availability heuristic.
Another common mental pitfall: impact bias, or “being influenced by inaccurate projections of future states,” the paper says. The researchers’ example: a patient who is eligible for a colostomy is so convinced he’ll be unhappy afterward that he refuses the procedure, despite studies showing most people who do get one wish they’d done it sooner.
Those biases “are so strong that they can push people into decisions that are potentially against their long-term goals,” Jennifer Swindell, an author of the paper and an assistant professor at the Center for Medical Ethics and Health Policy at Baylor College of Medicine, tells the Health Blog.
The article then gives examples of techniques physicians might use to counter them and improve patient decisions. For the 30-year-old seeking a mammogram, for example, a doctor could frame the issue in terms of the absolute risk of developing cancer at that age and also focus on the risks of false-positive results.
Swindell also emphasizes that doctors need to be careful about making certain judgments. For example, refusing certain medical procedures — if based on deeply held convictions like religious beliefs — may be in line with a patient’s long-term values.
But, the paper concludes, using “knowledge of decision-making psychology to rebias patients to persuade them to engage in healthy behaviors or make good treatment decisions is ethically justified when the patient’s” biases or mental tricks are “distorting their decisions in harmful and potentially correctable ways.”
Bonus behavioral economics: Read how employers and insurers are using behavioral economics to help people make healthier choices.