Salience

Enhancing Patients’ Treatment Adherence

Behavioral economics teaches that one of the ways in which the human mind is not logical is that the brain focuses on and overweighs colorful events that stand out rather than statistically more common but less colorful events. There are many examples of this. Consider fear of flying. Some people are terrified of flying having heard of plane crashes. Plane crash events make the news in a big way. But driving a car is far riskier, with perhaps a thousand-fold more deaths than plane crashes each year. Most of the auto-related deaths don’t come to our attention in anything more than a statistic, while a plane crash will be presented to us in far more gory detail.

Fear of terrorism is quite similar. The fear is intense; the real risk, statistically, is miniscule. Yet while Congress will go to any length to fight terrorism, there is far less effort spent on protecting the public from the far larger risks we face. Nearly every fatal disease (not to mention auto accidents), no matter how rare, is a more likely cause of death than terrorism. But terrorism is salient, it is colorful, and it stands out in our minds and our politics.

Giving patients dry statistics about risks of disease is not a powerful way to change patients’ behavior. Skin cancer is quite common, but telling patients that a million people a year get skin cancer isn’t moving. Telling patients they can prevent skin cancer by regularly wearing a wide brim hat or by using sunscreen isn’t compelling. Instead, giving the patient a salient example— letting them know that such measures might prevent them from getting a golf-ball sized, necrotic, odious, ulcerating tumor of the nose that would need to be cut off along with the nose (but not to worry, the rubber prosthesis to cover the hole will look just fine)—will present patients an unforgettable mental picture that would be far more motivating. Similarly, telling patients with diabetes or hypertension about statistics on shortened lifespans can be anticipated to be less impactful than painting a detailed picture of what a single life could be like without sight, kidney function or distal lower extremities.

 —Dr. Steven Feldman is a professor of dermatology and public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC, where he studies patients’ adherence to treatment. He is also Chief Science Officer of Causa Reseach, an adherence solutions company, founder of www.DrScore.com and author of “Compartments”.