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Trust us, we’re paying the doctor

Published: 05 Mar 2014

Apparently, if I took you into a cake shop that had 50 cakes on display (all looking equally tasty) and asked you to choose one – you might not. If they only had three cakes left, you are 10 times more likely to indulge.

Sometimes having more choice, perplexingly, paralyses our ability to choose.

It doesn’t stop there. When we do choose from a list of plenty, we can regret the choice we made. It is easier to imagine that we’ve picked the wrong one. We rue the 49 missed opportunities and perhaps even start to resent the cake we have in front of us.

Barry Schwartz, in his book The Paradox of Choice, goes even further. He claims that because there is so much choice nowadays we are unhappier. He argues that with the escalation of choice, comes an “escalation of expectations”.  The cake, so happy to be picked, suddenly feels the pressure of being chosen. It has further to fall. 

If you are like me, you’ll eat the cake anyway. Unless it is the best cake ever – there is a worse bit to come. The realisation that it wasn’t the cake’s fault. It was ours. We should have chosen better, we failed and we only have ourselves to blame.

I have been thinking a lot about choice recently. Especially the choice that private medical insurance (PMI) customers appear to have when faced with making decisions about their, or loved ones’, healthcare.

PMI providers strive to give their members choice. Choice about which doctor they see, in which hospital and at what time. Buying PMI is, in many regards, buying choice.

Don’t get me wrong, I like choice. We have fought for and defended our freedom of choice. I would suggest that we work to earn more choice.

The problem, for me, comes when people are asked to make a choice with inadequate information and without the chance to process their decision.

Generally choosing cake is a luxury - but what about if we were hungry, really hungry and could only pick once. Whatever cake, right?

Or, actually, that wedge of sponge – it looks the biggest?  Hang on, the fruit cake is denser and so will be more filling.  Yes, the fruit cake.  Oh, wait a sec, that shortbread square has got nuts on and I remember reading that nuts were good to eat when hungry – I think?

Would you prefer it if I chose for you?

In my clinical practise, the most common question I’m asked is “if you were me doc, what would you do?”

In healthcare, if there is a choice – then there is not an obvious, stand out, answer. Processing the options, whilst scared and dealing with life changing news is near impossible.

This is coupled with the fact that you simply cannot take the risk of being wrong when the decision is about you or your family.

Rather than choice, I propose, people would prefer to have trust. Or even faith. The NHS has famously been described as almost a religion.

In most things where choice has increased, so has the information available. However, despite increasing choice in healthcare being a key objective over the last decade, this has not been matched by an increased ability to make an informed choice.

This is not necessarily due to a lack of effort to make information available, mostly the data is just not there and when it is – it is not understandable.

Our role as providers is to free people from the fear of uncertainty. In PMI, that means that we take on the responsibility to do the number crunching and data interpretation for our doctors and hospitals. And when the data is not there, we  will start actively recording and monitoring it.

These functions are going on in the background across the sector and, I hope, this reduces the uncertainty for PMI customers.

It is our job to collect and understand the information we get from the doctors and hospitals we commission on our customers’ behalf.

Using this information, allows us all to best direct customers to the care that they need to get better – even if that sometimes means presenting fewer choices.



Dr Umang Patel is clinical transformation lead at Aviva UK Health

This article is also available on Health Insurance Daily and comments can be made here.


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