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Unraveling Irrationality in Heath Care

Reasoning defines human intelligence, yet we all too often make choices that utterly defy logic. We’re impatient or irrational—or both—even when it comes to ensuring our own good health.

An earlier post covered the huge risk of overprescribing antibiotics. Overuse exposes patients to potentially dangerous side effects, wastes resources, increases antibiotic resistance and spurs the growth of nasty superbugs. As many as half of all antibiotic prescriptions in U.S. hospitals are unnecessary or inappropriate, according to the Centers for Disease Control and Prevention.

But when we’re sick, we want our doctors to do something tangible to make us better. We can get pushy about walking out with a prescription—better living through chemistry. Our doctors want to satisfy us, so even when they know an antibiotic won’t help, like in the case of viral bronchitis, they send us home with one.

Most of us can empathize with both the patient and the physician in this all-too-typical scenario. But that doesn’t dismiss the fact that neither party is behaving rationally.

Dr. Douglas Hough, an associate scientist at the Johns Hopkins University Bloomberg School of Public Health, researched this phenomenon in his book Irrationality in Health Care: What Behavioral Economics Reveals About What We Do and Why. He also spoke on this topic last fall at the inaugural conference of the High Value Practice Academic Alliance, a group of more than 80 academic medical centers that Johns Hopkins leads. You can watch this video to understand better how we’re influenced by biases, framing and opt-in vs. opt-out defaults without even recognizing it.

We have to unravel this irrationality by getting to the heart of the behaviors that guide both patients and providers. Then we can focus on how to eliminate unnecessary or low-value tests, medications and treatments, and rethink the fee-for-service model that compromises the quality of health care worldwide.


Karen Haller

Vice President, Nursing and Clinical Affairs | Vice President, Americas Operations As the vice president of nursing and clinical affairs, Karen Haller oversees nursing and clinical quality for Johns Hopkins Medicine International (JHI). She develops the structure and resources needed to collaborate with health care organizations around the world and supports international patients seeking care at Johns Hopkins medical institutions. She also provides leadership and strategic oversight for JHI’s clinical, consulting and knowledge-transfer activities. Click here to learn more about Karen.

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