Sometimes how you decide matters more than what you decide. The thoughts that lead up to a decision can be more important than the decision itself. This counterintuitive notion was first discovered in the 1960’s with behavioral economists Daniel Kahneman and Amos Tversky.
They discovered the mind has – generally speaking – two patterns of thought, one fast and one slow. The slow, methodical thought process is the one that generates the most prudent decisions. But the fast process is what we mostly fall back on. And healthcare is no different.
We rely on reflexive thinking in healthcare. It is the essence of outpatient care. Patients after patients line up, waiting hours on end, spending minutes with a physician who spews the most apparent diagnosis with the most obvious treatment plan, before moving on to the next patient. Time is of the essence, so there is no time for deliberation – come in, get triaged, wait, get seen, and get on your way. The process has become so routine that we have come to accept it as standard of care.
But we never stop to question the utility of it, whether there is a better way. We simply dig our heels into this mode of thinking and press onwards. So when we think about healthcare innovations, we think in the same way, we think fast.
We rapidly identify opportunities for improvement in healthcare. We create widgets and apps to address those opportunities. And we quickly pilot them, looking for the most apparent outcome. We tout success without knowing what success is because that is what you do when you think fast. Eventually, we define success through the same way of thinking. Whatever helps to think fast is a success – regardless of whether that definition of success matters for patient care.
This explains the preponderance of meditation apps that do little more than provide an outlet for the stressed out to expressed themselves. These apps do not help with any tangible outcome, but they are easy to use – at least according to the surveys that have evaluated them. But few have tried to quantify stress and even fewer have tried to correlate stress levels with clinical outcomes. It is a matter of converting the subjective perception of stress into an objectively defined clinical metric – something often dismissed like a cheap magic trick because it does not jive with thinking fast in healthcare.
We like easy in and easy out. We measure success with tangible data that can be measured and compared – one input to one output – and like that, we are done. But when we apply that mindset over and over in healthcare, we find that the way we think has very little to do with the essence of healthcare.
Everything that is wrong with thinking fast is encapsulated by the Alzheimer’s drug, Adulheim. No clinical symptom or lifestyle metric was evaluated in the drug trial. No clinical correlation was drawn to data. Instead, the drug manufacturer submitted data showing how the drug reduces a protein marker, Beta Amyloid, which inconsistently correlates with the clinical symptoms of dementia.
What is a disease if not the symptoms it presents in a patient?
In our lust to quantify all things healthcare, we altered how we think about clinical care. We gravitate towards the discrete because that allows us to think fast. But in our rush to think fast, we gravitate towards convenient endpoints.
The pandemic has made it clear that healthcare is a system. The midpoints are as important as the perceived endpoints. When thinking in systems, there is no need to think fast because the process matters more than the decision. This might be a good thing because healthcare has had enough of thinking fast – especially during the pandemic.
Healthcare lost much of its credibility from studies with outcomes that were premature and from pre-published clinical studies lacking the appropriate analysis for accuracy. These are fast thinking problems. In our haste, we lost the prudence that comes with scientific rigor.
We should start thinking slow. We may end up making the same decisions, but at least how we get there will be more sensible.