Switch - Chip Heath [19]
An alcoholic goes an hour without a drink. Three sales reps out of fifty sell like crazy. A few Vietnamese mothers, with no more money than any others, manage to raise healthy kids.
These flashes of success—these bright spots—can illuminate the road map for action and spark the hope that change is possible.
3
Script the Critical Moves
1.
A doctor was asked to consider the medical records of a 67-year-old patient who had chronic hip pain from arthritis. In the past, the patient had been given drugs to treat his pain, but they’d been ineffective, so the doctor was forced to consider a more drastic option: hip-replacement surgery, which involves slicing open the thigh, wrenching the bone out of the socket, sawing off the arthritic end, and replacing it with an implant. Recovery from hip-replacement surgery is long and painful.
Then came an unexpected break in the case: A final check with the patient’s pharmacy uncovered one medication that hadn’t been tried. Now the doctor faced a dilemma: Should he prescribe the untried medication, even though other medications had failed, or should he go ahead and refer the patient for surgery?
This dilemma, based on real medical cases, was created by physician Donald Redelmeier and psychologist Eldar Shafir, who used it to study the way doctors make decisions. When doctors were presented with this case history, 47 percent of them chose to try the medication, in hopes of saving the patient from going under the knife.
In a variation on the dilemma, another group of doctors were presented with almost exactly the same set of case facts—except this time, the patient’s pharmacy discovered two untried medications. If you were the patient with the arthritic hip, you’d be thrilled—certainly two nonsurgical options are better than one. But when the doctors were presented with two medications, only 28 percent chose to try either one.
This doesn’t make sense. The doctors were acting as though having more medication options somehow made medication a worse bet than surgery. But if 47 percent of doctors thought medication A was preferable to surgery, the mere existence of a second medication shouldn’t have tipped them toward surgery.
What happened here is decision paralysis. More options, even good ones, can freeze us and make us retreat to the default plan, which in this case was a painful and invasive hip-replacement surgery. This behavior clearly is not rational, but it is human.
Decisions are the Rider’s turf, and because they require careful supervision and self-control, they tax the Rider’s strength. (Remember the radish/chocolate-chip cookie study from Chapter 1.) The more choices the Rider is offered, the more exhausted the Rider gets. Have you ever noticed that shopping is a lot more tiring than other kinds of light activity? Now you know why—it’s all those choices. This is important, because we encounter excess choice all around us. Consider three real examples of decision paralysis:
Scene 1: A gourmet food store. The store managers have set up a table where customers can sample imported jams for free. One day, the table showcases 6 different jams. Another day, 24 jams. As you’d expect, the 24-jam display attracts more customers to stop by for a sample—but when it comes time to buy, they can’t make a decision. Shoppers who saw only 6 jams on display are 10 times more likely to buy a jar of jam!
Scene 2: The office. The employees of a large company read over their 401(k) materials, ready to start saving for retirement. The human resources department has thoughtfully provided many investment options: domestic growth stock funds, domestic value stock funds, municipal bond funds, real