Future Now
The IFTF Blog
Can Doing Nothing Feel Empowering?
There's a lot to like about this feature by Christie Aschwanden about the difficulties of communicating information that contradicts our beliefs. Aschwanden does a solid job of summarizing a fairly substantial body of research showing that in everything from health care to politics, we instinctively question information, however solidly researched, when it challenges our current thinking. For example, one study found that "Reviewers not only gave the paper higher marks when it confirmed their previous views... they were more apt to detect an inadvertent typo in the manuscript when the results contradicted their pre-existing beliefs."
But what really struck me about Aschwanden's piece was her emphasis that we most of us hold a belief that action is inherently empowering, and as such, we have trouble listening to any message that says that it's okay to not immediately do something.
[T]his evidence-based message isn’t an easy sell. “Sometimes it’s better to do less, but that answer doesn’t sit well with Americans; it sounds like a loss of resolve or capitulating to the enemy,” Berkeley psychologist MacCoun says. People go to the doctor seeking a quick cure, not advice on how to make themselves more comfortable while they wait for natural healing to occur.
And plenty of doctors are willing to offer aggressive means... An examination of more than 3,500 patient visits published in the Feb. 8 issue of Archives of Internal Medicine found that even though practice guidelines recommend against routine imaging for low back pain, 1 in 4 patients was nonetheless referred for imaging tests. Doctors want to offer their patients a tangible solution...
Whether or not the “do something, anything” approach is effective, aggressive action feels empowering to doctor and patient alike. In fact, studies have shown that patients who get more high-tech spine imaging are more satisfied with their care than those who don’t, even though their outcomes are no better, and in some cases worse, than those who didn’t get the imaging...
In part, these and other examples are a reminder that some incredibly emotional challenges can be made to sound dull and clinical. Lower back pain may not be an emergency to the medical system, but it can be an emergency for you.
Naturally, in the face of emergencies, we want "tangible solutions." In fact, all of Aschwanden's examples in health care shared this general theme: In spite of solid evidence showing that action was unnecessary, people felt the desire to act.
Doctors go to medical school because they believe that they can defeat life-threatening diseases. Most patients feel, or at least want to feel, the same way--particularly by the point that they go to the doctor or hospital. It may be the case that a test or pill won't do any good, but who wants to take an hour or two to go to the doctor only to be told that the action to take in the face of this personal emergency is to watch carefully and hope nothing gets worse?
The importance of this feeling--that doing unnecessary stuff is empowering--is easy to underestimate. We do too much all the time in all sorts of contexts--for example, the first part of Tim Ferriss' bestseller The Four Hour Work Week mostly boils down to him recounting the emotional difficulty and challenge of learning not to unnecessarily do stuff. In health, the stakes are much higher, and the impulse to do everything possible seems likely to be that much stronger.
Aschwanden concludes her piece by saying that:
Explanations that offer hope and empowerment will always hold more appeal than those that offer uncertainty or bad news, and when new evidence offers messy truths, they must be framed in a positive light if they’re to gain traction.
The Four Hour Work Week was popular, I think, in part because it had an empowering message: Do less work and you'll be more productive and have more free time. I'm not sure what that message sounds like in health care. Doing less may make more sense statistically in a lot of cases, but it's very, very difficult to make a wait and see approach feel empowering in the face of a problem that also may very well feel life or death.