Weight Management; Why We Make Mistakes

Recently, I picked up Joseph T. Hallinan’s book “Why We Make Mistakes; How We Look Without Seeing, Forget Things in a Second, and are Pretty Sure We are Way Above Average”… And while the title reminded me of the line from Garrison Kiellor’s, ‘A Prairie Home Companion’ radio program, the gist of the book reminds me much more of the struggles most of us having in making good choices about our diets and wellness.

Especially interesting is that we seem to be “hard-wired” to commit many of our mistakes. Ironically, we tend to make mistakes even when we are consciously and actively trying to improve our health.

5 Health Mistakes We Need to be Aware We Make

We Look but We Don’t See
We Walk and Chew Gum, but not Much Else
We are in the Wrong Mind Frame
We’d Rather Wing It
We Don’t Constrain Ourselves

When we look at things, food included, we tend to spend more time on the context of the item than the details. When it comes to food, this is especially true. Food is largely contextual: popcorn at the movies, turkey at Thanksgiving and cake for your birthday. Hallinan says that the meaning matters, details don’t. Each of these foods has a meaning within their respective context. Contextual foods, by their very nature, tend to be foods in which we over indulge. So, the challenge is to recognize that we are very unlikely to be in a detail mindset when we are eating foods in context – we eat automatically without mindfulness. How do we combat this? Look for all the occasions at which food is in contextual and see if you can stop for a moment and focus on the details. Does the popcorn come in different sizes, unbuttered? Can we opt for the a smarter choice and still enjoy the context. Would one scoop of ice-cream instead of three satisfy the context of a treat at the beach? Of course it can! Yet, our lack of awareness of the details of our choices causes us to make poor decisions. Knowing we have this propensity to overlook the details, can often be enough to help us make better choices and make less mistakes.

We can drive and eat fast food but not much else. For example, have you ever been driving with a snack and suddenly you find yourself wondering when you ate the last bite? You ate all the food without knowing you had finished. Whereas, we pride ourselves on our ability to multitask, we are not computers. We simply don’t we move from one thought to the other and back processing both things as we go. The positive part of being surprised that you ate the entire burger without knowing IS that you were actually paying attention to what you needed to do, DRIVING. You were consumed by what you needed to do at the time. The mistake is not bad driving, the mistake is that you could not manage the details of what you ate and you likely ate too much. So, with this in mind, the drive-thru is the place you needed to make the right choice. The trick is to order only the amount you require when at the window, don’t buy the biggest thing and rely on a judgement to take place when you are on the road.

We are anchored buy all kinds of sensual stimulants. When French music is playing more wine is sold. When football is on TV more pizza’s are ordered. These are also context foods and in these cases the context was created for us from our past memories. Additionally we are susceptible to being ‘anchored’ to a ‘new’ context that might not have existed previously. Anchoring devices can make us look at things incorrectly because they set our relativity. For instance, there is no difference in price between $.50 a can of soup and 4 for $2. Still, stores use this all the time because they know the mistakes we make. Even if you only need one can, you have already been introduced to the idea of buying four. ‘Hey, everyone is doing it, must be a good deal’. We find it challenging to forgo ‘deals’ like this or buy individual items in offers that are bundled, even when we have no intention on buying the more than a single item. So, be careful not to let your mindset be altered. Challenge yourself: find “2-for” and “5-for” offers, then just buy one, see how you feel.

The food we choose is one of the most important decisions we make. Still, there are times when we pay very close attention to our choices and other times when we simply wing it. I have a friend who studies every label in detail at the supermarket yet eats out at restaurants 4 times a week and have no clue as to the details of his meal. He has chosen a shortcut system that suits him – when he is in a restaurant he permits himself to wing it. We think we make better choices than we actually do. We are pretty sure we are well above average. We analyze all the labels, don’t we? Yet, for many of us, a huge percentage of the food we take in is “unsupervised”.

So, yes this takes to the last item – constraint. Our eating “mistakes” are a function of our ability to create and follow the guidelines we make for ourselves. However, I bet you are not surprised to find that we are not all the good at that either. We not only fail to follow our own guidelines, we tend to make the same mistake over and over again. Or when we make the mistake again, we simply create another guideline with the hopes it will keep the guideline we just failed to comply with – in check. I think that the trick to all of this is to make the guidelines you want to follow, and then create a system to follow them without consciously following them. A good software user interface designer once told me that you want to get your user on the luge run and have them follow through the process by making all the turns and making progress, but never leaving track. I think we can all benefit from this idea when it comes to making mistakes in healthy behaviors. Spend time thinking about where we make these mistakes and see what paths we can create for ourselves that keeps us on track and at the same time moving forward.

The Patient, Payer, Provider Triangle.

Hey Look, another Healthcare Conference!

It is true that I am once again sitting at a conference on the future of healthcare delivery. We just hit the mid-part of the day and after the first 2 sessions and the Payer, Provider, Patient triangle has made its appearance is just about every presentations deck.

If you have not seen it it looks something like this:

The general idea is that the Patient’s role (that is you) is to give their money to the Payer (insurance). The Payer will be the financial advisor of the care you will get from the Provider (doctor).

The Conflict:

The conflict that exists in this triangle are quite apparent if you take a moment to think about it.

The Payer’s first priority to its shareholders is to maximize profit while at the same time, arbitrating a level of care that is meets the minimax (1) standard of care.

The Provider wants to maximize the amount of care they can provide up to (and at times exceeding) the prayers guidelines to pay.

The Patient wants to minimize the initial outlay and maximize the care.

The Incentive Missmatch:

So, I thought for a moment about the what is the best case for each of the actors.

For the Payer the best case scenario is pretty straight forward. Take in the maximum premium they can charge in a pure demand side market. Followed by paying out the least possible amount the can in claims.

For the Patient the best case scenario is also pretty straight forward. Receive the highest standard of care available on the planet at the lowest cost.

These economic models very straight forward. They variables are pretty straight forward.

The Messy Part:

The Provider system is where the incentive problems are most complex. There are hundreds of incentive mismatches every time a Patient touches this system. All the choice points in this system are mind boggling. Take a simple check up. First off, should you even have one at this very time? Next, if so, what test should be performed? How much interview should the each provider from the front desk to the nurse’s aid to the RN to the Physician’s Assistant to the Physician spend with you to identify your current state of of being. And all of this before there is any indication that the Patient has a condition that needs to be treated. You can repeat this at each an every Provider point of service, from the way a counter is set up at your local drug store to how the most technically advanced Neurosurgical center is set up.

The Politics:

As, I illustrated the incentives for the Patient and Payer are fairly straight forward economic model. This also seems to be the focus of the competing theories of reform. Whether conservative or liberal, most people agree that some sort of external pressure needs to be exerted on the Provider system to improve care and improve efficiency (some might confuse these as mutually exclusive ideas).

The general political difference is the more conservative view is Patient market drivers on the Provider system will lower cost and improve outcomes.

The moderate view (our current ACA, also called ObamaCare) is a model that regulates the economics that exist for the Payers, by requiring them to work more closely with the Providers of all types to fix/improve the inefficiencies. Additional pressure is supposed to come from the Patient on the Payers to do the ‘right thing’ as the financial advisor/arbitrator for them in the provider market. (Just a note: this has not been implemented yet.)

The more liberal view is to remove the current Payer as a commercial economic player all together and replace it with a single Payer that is governed by the Patient through representation.

Until We Change:

The irony is that the current system has placed the most of the responsibility for arbitrating the economic conflict between Patients and Payers squarely on the system that is most complicated economic system in the triangle… The Provider.