Patient Compliance Subverted By The Temptation Of Now

12-14-2006 | Categories:

I Want It Now! The curious economics of temptation By Tim Harford Slate.com Nov. 25, 2006



While this brief article at Slate.com, an entry in that online publication’s “Undercover Economist” column, does not mention healthcare or compliance, the applicability of its message to those areas is apparent. That message is set forth in these two excerpts:

Mainstream economics … assumes people are impatient in a consistent way: If I would rather have $110 on Dec. 6 than $100 on Dec. 5, then logically I would always be happy to wait a day for a gain of 10 percent, and I would rather have $110 tomorrow than $100 now. Most people do not actually behave like this. The “now” has a strong pull. Almost everybody says they are happy to wait a day at some future time, but not today. They would prefer $100 today to $110 tomorrow and, while they say they would prefer $110 on Dec. 6, come Dec. 5, if you ask them again, they will change their minds …
One of the results of the recent research is that we have a sense of just how strong the pull of the now actually is. The answer is that anything on offer right now is worth half as much, again, as it would otherwise be; that also means that any immediate cost, such as the pain of going to the gym, is similarly inflated. (That is, you’d much rather go to the gym next week than today.) Of course, the costs will vary across people and across temptations, but that seems to be a consistent finding.

The author goes on to point out the utility of this insight, describing, as an example, a plan called:

“Save More Tomorrow,” in which employees make commitments to contribute to their pensions not now, but later. Early trials show dramatic success in increasing contributions.


Commentary

Every clinician has dealt with the patient who will follow his blood sugars assiduously, take her pills precisely as prescribed, or adhere to his diet – tomorrow. The idea raised in this article should, at least, remind physicians that it’s likely that the patient’s explanations are manifestations of the value he or she places on immediacy rather than a failure of will power or an excuse offered in hopes of avoiding compliance.

And, perhaps lifestyle shifts (e.g., terminating smoking) are more likely to be effected if the clinician recommending the change suggests that the commitment to change be made now with the actual behavioral alteration taking place in the future.



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