"Patient medical sceneのaction Jing Qi learnーsu me cry offenders u healerと" (Toyo Jing Ji News Agency)
recently read a book to explain the medical scene from the perspective of behavioral economics at the problems encountered, together with the Civil Aviation hospital doctors killed event, but feel the need to share the content of the book, in order to promote understanding of all doctor-patient relationship.
Foreword
Imagine a scenario: For a patient with advanced cancer probably only adhere to three months, the doctor said to him, "It is now no possibility of any treatment, and its treatment of pain, it is better to go home to do what you want to do it . ", the patient's response is," you do not say cure, it is to say let me die. I will not let you rule the. "patients may feel that doctors have no medical ethics.
The doctor made an objective decision, but did not understand the psychology of survival in patients with advanced, that would rather accept the strong side effects and can actually shorten the life of the treatment. This behavioral psychology in economics is called loss aversion , people tend to avoid the loss, often choose the option with the possibility of even only a slight reduction in the loss of. From the doctor's point of view perhaps also wondered why patients do not believe the statistics do not want to make a rational choice. Patients and doctors thought so diverge.
In the early popularity of medical knowledge not a lot of time, as long as the doctor believes the right to choose their own therapy, the patient Dr. Ren You to choose, so the patient will usually hide the fact that I had cancer. With the popularization of medical knowledge, it had also been part of the post by the action of the many doctors choose treatments with the patient, in the case of the two sides share information hundred percent, the patient should be able to make more than the unilateral decision by a doctor conducive to their own treatment decisions, such as the patient can choose to have fewer side effects, less painful treatment to spend the rest of his life. However, the way to provide information but may result in therapy the patient is unable to make a real decision in their favor.
Today, informed consent in this way is a way of widely used. The doctor will tell the patient medical information in the patient fully understand the contents after treatment, after-effects, the possibility of side effects, doctors and patients both parties to make a unanimous decision. However, medical information itself is very complicated, we can not expect patients to fully understand the information and make the best decision. Traditional economics assumes that policy-makers as "rational man" that he can be subjected to objective and precise calculations to make the most favorable decision. But the people making decisions are not always rational, there will always be prejudices or bias (Bias), so even for the same background information, provided, even if it is there are different ways to provide information, people may also make different decisions. In order to make a more favorable medical decisions, whether patients or physicians need to be aware of the limitations of such a deviation exist as human beings we thought.
In order for people to make decisions to ensure the freedom of choice in the case of the maximum, to make better choices, we need some skills. A typical technique is to boost (Nudge), is meant to gently push the elbow with other people. For example if companies want employees to try to join corporate pension plans, you should not let employees the freedom to decide whether to participate, but you can use the default for all employees were to join, but at the same time providing simple procedures exit options. In this case, even if the pension plan is easy to quit, but most people actually will not quit, because we generally accept the default option, will not easily change. So in the medical scene, the doctors informed consent information can also be used in such a way to obtain the result of joint decision-making (shared decision making) a.
What is the medical behavioral economics
Sunk costs (as I have paid a lot, so do not want to give up)
For example, cancer patients a decade, there have been symptoms of heart failure, although the tumor has not been controlled, but the doctor recommended to stop the anti-cancer drug, the first cure heart problems. In this case the patient would believe that insist on eating a decade of anti-cancer drugs, can not be easily stopped, it may be because the side effects of heart attack and died before even objectively lead to patients being down with cancer. Eat a decade of anticancer drugs that act itself is a "sunk cost", although it is the cost, but can no longer be recovered, can not play any impact on the current decision-making. Like the stock market to recover high, sell low, buy or ten years, but wearing clothes reluctant to throw, that had spent a considerable price to buy is throw a pity, but do not throw results not only can not buy clothes and money chase but come back and occupy the space at home to bring the cost of maintenance. So this doctor should not allow patients to tangle in the past to pay the cost, but fully aware of the greater risk of future non-stop anti-cancer treatment to be faced and the possible benefits stop after anti-cancer drug.
Maintain the status quo preferences (I am not very good for you?)
For example, a patient with lung cancer bone metastasis has occurred, doctors recommend that patients say let the pain specialist consultation, early on in the future due to the pain caused by bone metastases treatment, patients thought that medicine is now quite good, though bones began to hurt, but they can also insist, no need to go to a doctor, plus the new drug. Patients have this idea because people tend to maintain the status quo, change the status quo that is, will it as a loss, Popular point is, people will be warm boiled frog. So how do you make a favorable decision to promote patient? Since the patient attention to the "status quo", then the status quo will change the status of the patient understood doctors so understanding, telling the patient "For the patient began to use the first two kinds of anti-cancer drugs we have an obligation to inform them, if severe pain after and I opened painkiller achieve results when you need pain specialist consultation, which is the standard treatment. " So that patients recognize that maintaining the status quo is not a treatment program now, so that the status quo is the pain the family physician consultation.
Current preferences (Present Bias I do not want to make a decision)
For example, for critically ill patients in the ICU state of treatment, doctors told family members "Now you can see the situation, in my experience if his heart stopped, even if doing cardiac massage is basically a heartbeat can not be restored, will only make patients are more painful, "so you see if a heartbeat stopped, then we are not treated or do heart massage it? "Family members say," I now have a moment can not do such a big decision, let me think about it ", but the next day, the family is likely to remain or continue with great responsibility reason to postpone making a decision time. This when a doctor or nurse can tell their families: most people in this case in order to prevent the suffering of patients generally do not choose to do so the families of cardiac massage to be consistent with the general behavior, it may well make a decision.
Availability preferences (availability heuristic is not a magic pill, I heard that cancer can be cured?)
For example, there was a patient found he had cancer in the physical examination, doctors recommend regular treatment began taking anti-cancer drugs or chemotherapy. But the patient said: "Two days ago I saw a newspaper still wine ** ate like a man's cancer, but was said to have no side effects, so or I'll have some of that wine, it is incurable of then the anti-cancer drug it. ". This is because people make decisions is not called when the overall objective of background knowledge, but based on the information easy to think it is easy to do or to make a decision. For example, the Internet can hire such an example, the experimenter asked participants English vocabulary word is "r" at the beginning of multiple (eg roof), or "r" is the third multi-letter word (eg circle ), since the beginning of the word r is easy to think, but in the middle of the word is difficult to think of it, so people will simply the conclusion that the number of words beginning with r and more. So in the medical scene, the doctor can tell a patient he saw the so-called magic pill actually exaggerate the effect of publicity, maybe one of two people happen to eat this drug also had effects, but more people are faced with the symptoms instead further deterioration. In the case of patients aware of the existence of such availability preferences, if God can confirm some harmless medicine to take, then we can advise patients to take regular treatment at the same time, try magic pill.