Bryan Caplan  

Acting "As If" Hanson's Right

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Last week I went to the doctor for an ear infection. Did I die from the hypocrisy? No, I knew from childhood experience that ear infections are one of the few things doctors can easily cure. Of course, my first choice would have been to live in a country where adults didn't need to beg doctors for permission to buy medicine, but going to the doctor was better than letting nature take its course.

Today my phone rings. It's my HMO conducting a survey about my experience. My reflexes told me to hang up, but I wanted to learn more about (a) how surveys actually work, and (b) the health care industry, so I stayed on the line.

Along with the obvious questions (age, race, education), the survey had roughly five substantive questions about my appointment. Three at least arguably fit the usual "doctors repair the human machine" model of health care. On a scale of 1-5, how satisfied was I with the whole experience? How able was the doctor able to answer my questions? Something like that.

But TWO questions were glaringly consistent with Robin Hanson's story that health care is largely about "showing that you care":

Did you feel comforted?

Did the doctor show you respect?

Note well: Neither of these components of consumer satisfaction have obviously improved over the past hundred years, or even the past thousand. Back when doctors bled their patients, I have no doubt that many "felt comforted," and thought their doctor "showed them respect." Indeed, I bet that today's most financially successful astrologers give a lot of comfort and show a lot of respect.

Admittedly, interpersonal skills matter somewhat in every service sector job. But it was striking that the HMO assigned them a very high priority. And the person who administered the survey sounded surprised when I said that the reason I was "fairly satisfied" was that "The doctor was able to solve my problem." Her tone said: "Oh, that's why? It takes all kinds."

It's almost as if people on the business side of the industry have a gut level sense that Hanson's on to something. Almost as if.


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COMMENTS (8 to date)
paul writes:

Good discussion, Robin's right...

There is a corollary to this in investment management. Diversifying your assets and keeping your costs low is the key to long term savings. Similarly, eating a well balanced diet and exercise is the key to long term health. People pay a premium for “professional advice ans sevices.” Why this premium persists is largely a function of the amount of regulation that exists in both the financial and health care sectors.

Phil writes:

Perhaps this is the result of a knowledge problem. Patients have no way of evaluating whether the doctor should have solved their problem, or should have produced better results. So they are forced to evaluate doctors on other aspects of care they *can* evaluate, such as being respected and put at ease.

Bernard Yomtov writes:

These questions may have had somethig to with malpractice issues.

I think that research shows that doctors who are seen as caring and concerned are vastly less likely to be sued than those who behave brusquely. This is independent of the actual quality or outcome of the treatment provided.

Sharpshanks writes:

good post. i just read an interesting study that showed mom's who ask more questions when their child is in the hospital wind up with shorter hospital stays for their children and usually better results. is that because questions are therapy? if so, maybe the survey was part of the treatment... you know, to see how well your ear is working!!!!!

vince_card writes:

It seems likely that feelings of comfort and respect are predictive of customer satisfaction, perhaps even moreso than the effectiveness of the resolution (perhaps because for the latter expectations are low). If that is the case, can we rely on a consumer based health care system to achieve the outcome of efficient maintenance of the health of the population. If one objective of a consumer based system is to reduce cost by making the patient more responsible, how does one move the patient to a results based context of decision making (did the doctor fix the problem) in order to ensure that healthcare dollars are being spent to promote health instead of comfort and respect.

Nathan Whitehead writes:

It should be noted that getting comfort and feeling good about your doctor are tremendously valuable to people. I don't see that aspect of health care being a problem. The real problem is that one can't buy health, one can only buy health care. I believe the reason is that medicine is so regulated.

Michael Mandel writes:

Oddly enough, the efficacy of antibiotics in treating ear infections is one of those topics where there has been tremendous (and vicious) debate among doctors.

John writes:

If the HMO was looking out for its own financial self-interest--and if nothing else I expect them to be good at that--the questions about respect and emotional response to how you were treated (a) made sense and (b) were a metric used to evaluate their physicians' liklihood of being sued for malpractice.

My understanding is that there is a strong correlation between amount of respect a patient feels they are shown and their liklihood to file malpractice suits. Sorry, I can't cite it off the top of my head. It was referred to in Malcolm Gladwell's recent book, _Blink_. It's also apparently become common knowledge in the medical field: a friend of mine in her residency has already had two lectures about the role of treating patients with respect in an effort to reduce malpractice lawsuits.

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