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December 26, 2021
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We consider progress in healthcare as a march towards efficiency.
We strive for greater access to healthcare, better patient outcomes, and lower costs of care – all defined through a series of metrics, some clinical and some financial, all in service of efficiency.
But efficiency can only go so far. Eventually efficiency erodes into our behavior as patients. And when the yolk of efficiency curtails what we perceive to be our fundamental liberties, the march towards efficiency will have ended. It is that simple – and that irrational.
Most patients at risk of diabetes know to monitor their diet and remain physically active. Yet most do not maintain the behaviors necessary to stave off diabetes. As a result, diabetes is a commonly diagnosed condition in the United States.
It is also called a lifestyle disease, implying that certain lifestyles predispose patients to diabetes. Behavioral choices that many diabetics engage in that are harmful for their health. While behaving in ways that worsen a disease may seem irrational, it is also what makes us who we are.
Many families and cultures are defined by traditions of holidays and celebratory meals. Most of these traditions involve unhealthy behavior. But hardly anyone would suggest that we should stop celebrating and adhere steadfastly to a regimented diet. Yet this would be the ideal course of action. And to encourage otherwise would be irrational.
From this perspective, irrationality and efficiency are opposites in healthcare. In the march towards efficiency, irrationality is sometimes seen as an impediment – something to overcome. In recent years, we have attempted to make healthcare efficient through a slew of technological and financial innovations, advancing healthcare at a pace never seen before.
But it has not made healthcare efficient. For that, we need behavioral changes that we are simply not willing to make. We want to be irrational – at the cost of efficiency.
So far we have avoided directly addressing the issue, conveniently ignoring irrational behavior in the name of healthcare innovations as we march along the path of efficiency. But now we have come to where it is directly limited by irrationality.
In chemistry, complex reactions are defined by its rate limiting step. If we apply this analogy to healthcare, we would define healthcare by irrationality as it is the rate limiting step towards efficiency. Therefore, the value of any novel innovation or technology intended to make healthcare more efficient will be defined through the lens of irrationality.
We currently look at irrationality as implicit to healthcare – something to acknowledge but not necessary to directly address. In 2022, we must look at irrationality as an integral aspect of patient behavior and work to address it head on – discuss it directly with patients.
Currently, most current efforts that focus on behavioral change fall in the realm of patient education. Traditionally, this has meant discussing common symptoms and treatments for chronic diseases while raising awareness – with the goal of making patients behave in more health conscious ways. Unfortunately, this has proven not to work.
Despite the increasing prevalence of healthcare information and resources for patient education, patients continue to behave in irrational ways. Increasing access to patient information has not limited irrational behavior. We must stop assuming the two are related – patient education does not affect irrational patient behavior. We need new ways to study and address irrational behavior.
Fortunately, marketing psychologists have studied irrationality in consumer behavior for decades. In fact, some of the most famous marketing campaigns targeted irrational behaviors – by targeting irrational emotions and thought patterns in consumers.
It makes no sense to purchase a thousand dollar phone every few months, yet Apple has become one of the most profitable companies in the world by ritualizing irrational purchasing habits.
As counterintuitive as it may seem, healthcare must directly address irrational patient behaviors to implement the behavioral changes needed to become efficient.
We will face barriers when initially focusing on irrational patient behaviors. Some will say it is unethical to encourage behavioral changes in such ways. But eventually we will realize that patients are motivated by irrational emotions and thoughts, not by patient education or healthcare information.
Once we realize what truly motivates patients and encourage behavioral changes along those lines, healthcare will continue its march towards efficiency.
But for now we remain in a standstill – waiting until we learn that for healthcare to become efficient, it must become irrational.
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What we can learn from the 1918 Flu Pandemic as the Omicron variant spreads
Historically, most pandemics end within 2 to 3 years as the virus mutates into a less virulent pathogen and the population builds up immunity. This is what happened to the influenza strain behind the 1918 flu pandemic.