In the first group, the default option of referral only was chosen 53% of the time, while in the second group (which had that extra choice) the default option was chosen 72% of the time. Let’s think about this. When deciding whether to try ibuprofen, about half the doctors thought this was a good idea. But when faced with one additional medication option, fewer doctors thought any medication was worth trying.
This is yet another example of the “power of the default”, with a twist. In both cases the default option is referral to orthopedics. But many more people chose the default option when they were given an additional choice, which is the opposite of what one would otherwise expect when faced with an additional reasonable option. Instead, this extra choice made the decision more difficult. And when a decision becomes more difficult, the default option becomes even more powerful. And in medicine, as with most decisions in life, there are sometimes many more than two or three options. As the options increase, or as the decision becomes more difficult, the draw of the default increases. [Note, for the first group of doctors, one could argue that more than 50% should have suggested a trial of ibuprofen prior to consideration for hip replacement in the first group. It would likely be a very good idea to try this simple solution prior to concluding that medication has failed and surgery was needed. But the default option, the hip replacement, was also likely over-selected due to status quo bias.]
This power of the default option can be used for good, or for ‘evil’. A good waiter does not ask “do you want anything to drink besides water?” but instead “what do you want to drink besides water?” With patients, the way a doctor phrases a question obviously affects the answer. When requesting an autopsy, for example, we often ask the family to make a choice, and (in my experience) we often phrase the question such that “no autopsy” is the default choice. But what if instead the situation was framed as “We will proceed with an autopsy. However, if you’d like, we can cancel it, it’s entirely up to you.” I honestly think many more families would choose to proceed with autopsy, merely by the way the question is asked. This is hardly a revolutionary opinion, but it emphasizes that, for better or worse and whether we realize it or not, we can influence the decisions made by our patients not only by what information we provide, but how we provide the information.
Those who know me well realize this discussion is soon going to turn to personal finance. And they would be right. Cognitive biases are not limited to medicine of course, and they have been well studied in the world of economics and personal finance. These biases hurt us in many ways, and lead us to make poor decisions when it comes to money management and investing. Biases also make us particularly vulnerable to those who exploit these biases, e.g. banks and investment houses, insurance salespeople, investment advisors, basically, anyone who wants more of your money in their pocket. But I’m going to leave a discussion about cognitive biases and irrationality in personal finance for a future post (probably WAY into the future).
For now, I simply wanted to introduce cognitive biases to those (hopefully few!) physicians, and others, who may not be aware. Learn more about this topic, and you’ll be more likely to make better decisions more often. Do you think you aren’t all that vulnerable to cognitive bias? That’s a cognitive bias!