Psychologist Barry Schwartz gives a great TED lecture on “The Paradox of Choice.”1 He describes the ways in which our society generally considers choice and freedom to be uniformly positive goods, but he points out that too many choices can lead people to make bad decisions (an ironic curse of a wealthy society).
What a great world we now live in. I am old enough to remember having only one choice of a phone company. You could buy any kind of phone you wanted, as long as it was a black, dial phone. You could pick from any of five TV channels (I grew up in a major market). And you didn’t have so many restaurants to choose from, either.
Today, we have more and more choices. In fact, we have so many choices that we don’t know what to do. We go into phone stores and find it hard to choose from among the myriad options. With 1,000 channels on cable, we might spend all our time surfing them—and not really watch anything. We might be paralyzed just by trying to decide where to go for dinner. It takes precious mental energy to make choices.
Docs Ask, “What is Best?”
Today, we have many options for treating patients’ diseases. So many treatment options are available that patients have a hard time knowing what to do. Doctors may not know what to do either—having some options that may be a little less costly, versus some that are a little more effective, versus some that might be marginally safer. There may not be one right answer to the question, “What is the best medication?”
Behavioral scientists studying employees’ choice of retirement plans found that giving employees more choices made it harder to choose at all. And giving employees more retirement savings options caused more employees to forego making any retirement contributions. The solution to getting employees to participate is to switch to the default option. If the default option was changed to participate in a default plan if no other decision was made, far more employees, it turns out, signed up.
I use the default option to help patients choose and adhere to a single treatment, and tell patients some version of, “The standard approach is drug A, but you could also choose from among X, Y and Z if you prefer.” Encouraging doctors to think of your drug as the default choice, while recognizing the plethora of other options to consider, could be a useful way to help doctors help their patients to make and stick with a choice of treatment.