Boundedly Rational Patients? Health and Patient Mistakes in a Behavioral Framework

32 Pages Posted: 25 Apr 2017 Last revised: 17 Nov 2017

Ada Stefanescu Schmidt

Massachusetts General Hospital; Harvard University - Harvard Medical School

Ami Bhatt

MGH; Harvard University - Harvard Medical School

Cass R. Sunstein

Harvard Law School; Harvard University - Harvard Kennedy School (HKS)

Date Written: April 25, 2017

Abstract

During medical visits, the stakes are high for many patients, who are put in a position to make, or to begin to make, important health-related decisions. But in such visits, patients often make cognitive errors. Traditionally, those errors are thought to result from poor communication with physicians; complicated subject matter; and patient anxiety. To date, measures to improve patient understanding and recall have had only modest effects. This paper argues that an understanding of those cognitive errors can be improved by reference to a behavioral science framework, which distinguishes between a “System 1” mindset, in which patients are reliant on intuition and vulnerable to biases and imperfectly reliable heuristics, and a “System 2” mindset, which is reflective, slow, deliberative, and detailed-oriented. To support that argument, we present the results of a randomized-assignment experiment that shows that patients perform very poorly on the Cognitive Reflection Test and thus are overwhelmingly in a System 1 state prior to a physician visit. Assigning patients the task of completing patient-reported outcomes measures immediately prior to the visit had a small numerical, but not statistically significant, shift towards a reflective frame of mind. We describe hypotheses to explain poor performance by patients, which may be due to anxiety, a bandwidth tax, or a scarcity effect, and outline further direction for study. Understanding the behavioral sources of errors on the part of patients in their interactions with physicians and in their decision-making is necessary to implement measures improve shared decision-making, patient experience, and (perhaps above all) clinical outcomes.

Suggested Citation

Stefanescu Schmidt, Ada and Bhatt, Ami and Sunstein, Cass R., Boundedly Rational Patients? Health and Patient Mistakes in a Behavioral Framework (April 25, 2017). Harvard Public Law Working Paper No. 17-29. Available at SSRN: https://ssrn.com/abstract=2953250 or http://dx.doi.org/10.2139/ssrn.2953250

Ada Stefanescu

Massachusetts General Hospital ( email )

55 Fruit Street
Boston, MA 02114
United States

Harvard University - Harvard Medical School ( email )

250 Longwood Avenue
Boston, MA 02115
United States

Ami Bhatt

MGH ( email )

55 Fruit Street
Boston, MA 02114
United States
617-726-8510 (Phone)

Harvard University - Harvard Medical School ( email )

250 Longwood Avenue
Boston, MA 02115
United States

Cass R. Sunstein (Contact Author)

Harvard Law School ( email )

1575 Massachusetts Ave
Areeda Hall 225
Cambridge, MA 02138
United States
617-496-2291 (Phone)

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

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