Red On Marketing Blog

When people can choose a hospital, it is most likely based on their insurance, where their doctor practices, and advice from family and friends – but this information may not be accurate

I think that for lots of people, conclusions they draw about the quality of their healthcare are based on anecdotal evidence, subjective impressions, (faulty) memories of good or bad experiences at their doctor, whether or not the receptionist was friendly, and a host of other unreliable and irrelevant factors. People refusing to get vaccinations for their kids because they heard a rumor about autism or because of some hearsay about side effects is a good example. To make good decisions about your healthcare, probably more than any other decision in your life, you’ve got to get some objective, big picture evidence that accurately captures the reality instead of the narrow slice of your personal experiences. Resources like this one are the place to start. 
 
MM

Matt I think you make a good point. Lots of times people can’t (or feel they can’t) choose. If they can choose, lots of times the advice from family and friends is a big influence – but this information may not be accurate.

Matt the only thing I’d disagree with you on is the fact that back in the late 1970s it wasn’t hearsay but a real problem with the flu vaccines that made people sick as there was a definitive reaction to the shots. The percentages were incredibly low but that didn’t matter to those that ended up with Guillain-Barré syndrome. 
 
Also keep in mind that the most recent science seems to indicate those that got the flu in the earliest stages of the 1918 outbreak before it morphed into a much deadlier form had some protection/total protection from what came later on so there is some reasoning behind the idea of waiting. 
 
Either way I’d agree a lot of how we view health care stems from factors that are outside of the actual treatment.

Thanks for the responses. Perhaps it’s off the point, Green, but a few more words about vaccines. I don’t know the details from the 70s, but there’s a very simple issue here and it illustrates two points. Plain and simple, all other things being equal, if the mortality rate associated with a disease is much higher than the mortality rate associated with the vaccine, then it’s more rational to get the vaccine, period. If Guillian-Barre syndrome was a much less likely outcome with the vaccine than dying from the disease without the vaccine, then it’s the rational choice. 
 
If there are side effects and they are common, then the balancing of risks gets more complicated. There’s just no question now that when we view the numbers from high up, instead of following our personal, subjective impressions or listening to hearsay stories, modern childhood vaccines are more rational than refraining. The choice is made even more sensible by the fact that by refraining from getting vaccinated, not only does your child now face the increased risk of dying from the disease, but she becomes a vector for the disease in the population and can spread it to others. So the bad decision hurts your kid and other kids in the community. 
 
We all frequently make the mistake of applying inconsistent standards of risk across different activities. So we refuse vaccinations, but wear seatbelts; or we live in a town with a murder rate of 15/100,000 while refusing to go camping in a park where the danger is orders of magnitude lower. What seems to be happening is that a variety of factors skew our subjective sense of risk out of whack with the real danger. Hence the need to discipline ourselves to follow the big numbers instead of our unreliable personal impressions of how dangerous something is. If you’re a cop or an emergency room nurse, you think that drug abuse is the most serious problem facing our society, if you’re an otologist (ear doctor) you think it’s sticking foreign objects in your ear. If you are the 1 person in 10 million who has an adverse reaction to a vaccine, you think that vaccines are dangerous and should be avoided, despite the fact that thousands of people per millions of the unvaccinated will die without. 
 
MM

Green, McCormick and others — it does seem that, for many people, personal experience and anecdotes have a bigger effect on choices and actions than do statistical comparisons. Should those providing health information present statistics along with stories about real people? Are there some ways of communicating that are better than others when it comes to healthcare choices? How could we help people choose the best hospital, for example, knowing what we know about how people look for and absorb information?

I am not a good person to ask about how to improve the quality of healthcare in this regard because as I see it, people’s impressions of what good healthcare is are so far out of sync with what is good healthcare in reality. Bedside manner, personal relationships, and having certain kinds of feelings about their interactions with the doctor are so important with many people that they eclipse or at least obscure the real and important issues. The remedy, as I see it, can’t wait until they are in the examination room. They need to be relentlessly and rigorously trained in better critical thinking skills from an early age, then when they get to the doctor’s office, these problems won’t be such an issue.

Indeed, it does seem important to provide information about both the ‘what’ of hospital compare data and the ‘how’ of using the data plus other inputs to make a sound decision. One challenge is that the data is really hard to make heads or tails of at first glance! We tried to address that in an FAQ and by defining terms in the Communications Toolkit… 
 
In my mind, the best thing is to offer examples of sound decision making in action. A decision tree. 
 
For example, 
 
“After learning of XYZ health issue, Maria did these 5 steps to compare hospitals A, B, and C online [describe comparing on different measures, interpreting the bar charts returned, etc]. She also talked with P, Q, and R. She chose hospital B because…”

Yeah, some sort of procedure would be really handy. But these decisions are too complicated and diverse. I teach university level critical thinking in a philosophy department. Here’s a draft of a procedure/handout that I have been getting some good use out of. Sorry if it’s patronizing to just stick this whole thing on here, but it seems relevant. 
 
A procedure for better reasoning: 
 
Biases and Errors in Reasoning 
 
One of the ways to understand the host of thinking mistakes we make is in terms of a failure to conduct an adequate search for evidence. 
 
When we are confronted with some claim that is alleged to be true like, “Eating sugar makes children more energetic,” first, it will strike us initially without much critical reflection as either correct or incorrect. The inclination to believe or disbelieve is immediate and largely unconscious. 
 
Then usually, in conformity with that initial impulse to believe or disbelieve, we will conduct a cursory search of our memory for relevant information. We remember cases of children we have seen becoming hyperactive after eating too much candy, we recall gorging ourselves furiously on Halloween candy, we recall hearing many people make the claim. 
 
That is, we conduct a search for evidence that is merely consistent with the allegation. Unfortunately, for many of our conclusions, this is as far as any serious critical thinking about the claim goes. We are satisfied as a result of this process that the claim is justified and we conclude that it is true. 
 
This procedure is inadequate for several reasons. First, we should resist the temptation to accept the deliverances of common sense or unconscious intuition in these cases and we should resist the influence that that initial inclination has on our subsequent search for relevant evidence. 
 
Error: Believe first, then go find information to support second. 
 
Second, in general, having some evidence that is merely consistent with or seems to support a claim is not enough to render it justified. It turns out that humans are not very good at searching for a completely different class of information that is crucial to the question—what we need to consider before deciding is counter evidence. Until I have done that, I’m not entitled to draw a conclusion about the overall reasonableness of the claim. Suppose Smith, the gambler, has devised a method for winning at the slot machines that involves his standing up twice from his chair, turning around once, and tapping his right foot three times. If he plays a slot machine 100 times using this method and wins 4 times, he can’t reasonably conclude that his method works by only citing those 4 wins. So the commonly omitted question is: 
 
Have I adequately considered counter evidence? 
 
Error: consider only the information that I possess that seems to be consistent with the claim. 
So when we are confronted with a claim, before we can decide about its reasonableness, we should wonder about the overall adequacy of the information that we have readily available to us. Our memories are unreliable, we tend to look for confirmation instead of disconfirmation, and we tend to belief first and construct justifications second. One way to understand the justification problem is this: 
 
Question: If there were counter evidence to the claim, would it be available in my search? 
 
So I should strive to not overlook information that I have that might disconfirm it. And I should also wonder if the information that I have available to me is adequate with regard to disconfirmation. I might be selectively finding information in my experience that supports a favored hypothesis, or there might be some external factors that are biasing the sorts of information that I am getting. If we ask a cop about the severity of the drug problem in the United States, we will get a different answer than if we ask an Amish preacher. 
 
In fact, the tendencies to believe first and justify later, and to find only confirmation for beliefs are so strong that we all need to work hard to compensate. We need to actively and aggressively seek out possibly disconfirming evidence whenever possible. We need to cultivate this intellectual procedure: 
 
Search Phase: 
 
1) doubt first—don’t lend your assent prematurely. 
2) Consider the general adequacy of the information available to you—does it include possibly disconfirming evidence? 
3) If it is not adequate, don’t decide, investigate. 
4) Ask yourself this question: What would disconfirm the hypothesis? That’s where we should be looking. 
 
Evaluation Phase: 
 
5) Once we are satisfied that the body of information we have is adequate with respect to its potential for confirmation and disconfirmation, then we can decide what the evidence suggests overall. 
6) There are several mistakes that we habitually make in the evaluation of a body of evidence: 
 
Availability Bias 
Order Principle 
Discreditation 
Biased Assimilation 
 
7) Once we have evaluated the body of evidence while minimizing biases as much as possible, we can draw a conclusion: Gather adequate evidence first, evaluate it fairly, and then believe last.

Thanks for this. Incredibly clear. 
 
…That I have a lot of errors to avoid! 
 
Seriously though: someday I’d like to see your info about reasoning errors applied to the issue of marketing mistakes. Using passive voice because I know I won’t get to it soon… ;-)