Is doing something always the right choice? We see over 5,000 ads a day spurring us to take action. If it’s buying groceries or a new pair of shoes the stakes are low and our knowledge of need and the product is relatively high. However, what happens when the barriers to understanding are hard to hurdle? How do we decide when there is a wall of expertise or perceived complexity blocking your ability to make an informed decision?
Misaligned incentives and knowledge silos are at the center of many offerings. It is the questioning of if you need more than an oil change on the visit to the mechanic. Or if the eloquent high management cost hedge fund portfolios will really outperform simple low cost tactic. It’s wondering if this MRI is really crucial information to aide in your recovery. The consumer is often behind a perceived knowledge wall. And the information is silo’d behind a person with more than enough incentive to do something. In fact their finances and perceived self importance rely on it. The question we must ask is does this thing actually need done or is this person wrapped up in Do Something Syndrome.
In his excellent book, Risk Savvy, Gerd Gigerenzer outlines a study on defensive medicine in Spain reported that the majority of doctors choose a different route for treatment for their patients than they would themselves. Additionally, the are most often unaware of the patients preference for treatment. The doctor is incentivized to do something. Gigerenzer refers to this as SIC syndrome.
- The decision is highly influenced by the drive to practice defensive medicine (Self Defense)
- There is a lack of understanding of health statistics (Inumeracy)
- There is a clear financial incentive to provide a service (Conflict of interest)
This should by no means paint a picture of medical providers as calculated, self serving con artists. Providers despite their most pure intentions to serve the patients best interest are often handcuffed by a fee for service system with a rich history of litigious threats.
The system is rot with misaligned incentives. The antidote? Patient education, advocacy, and information transparency. The paternalistic “whatever you say doc” mindset must shift. The responsibility here must start with the provider. Include the patient in your decisions. Make sure their wishes align with your recommendation. Provide options for care and the data and rationale behind each rather than a directive. Until a system pays the provider for their expertise rather than for a procedural code, Do Something Syndrome will most certainly persist.
Gigerenzer G. Risk Savvy: How to Make Good Decisions. Illustrated edition. Penguin Books; 2015.