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Even experts try to avoid difficult decisions

One of the beliefs we have is that more choice is better. If we have more options, we are able to compare the options and make a better decision.

Or is it? Do more choices really enable us to make better decisions? 


Redelmeier and Shafir investigated this with a group of about 650 doctors:

  • Doctors were split into 2 groups

  • Both groups were presented with the case of a 67-year-old patient with chronic right hip pain

  • The patient had tried several treatment methods, all of which had not worked.

  • For group 1, doctors were presented with 2 options, and asked which they would recommend:

    1. Referring the patient to an orthopaedic consultant for hip replacement surgery; or

    2. Taking a course of ibuprofen, one medication that the patient had yet to try out

  • For group 2, doctors were presented with 3 options, and asked which they would recommend:  -

    1. Referring the patient to an orthopaedic consultant for hip replacement surgery; or

    2. Taking a course of Ibuprofen, one type of medication that the patient had yet to try out; or

    3. Taking a course of Piroxicam, the second type of medication that the patient had yet to try out. 


And the results? 

When there were only 2 options - hip replacement surgery or Ibuprofen, 72% of doctors picked Ibuprofen, while only 28% picked surgery.

The interesting finding is when there were 3 options. What happens? Now, almost half of the doctors send the patient for possible hip replacementOnly about 53% of doctors now prefer their patient to try oral medication.  


With 1 medication choice, the majority of doctors picked the medication. With 2 medication choices, we might expect that an even larger majority would pick the pills. Minimally, it should at least still be 72%?!

But the opposite effect occurs. Woah. What's happening?

If we think about the options, hip surgery is pretty major. In comparison, both medications are simple oral tablets.

When only Ibuprofen was available in group 1, half the doctors referred patients for medication. In group 2, when doctors had a choice between Ibuprofen and Piroxicam, surely there should be at least half the doctor picking medication? Even if they didn't like Piroxicam, Ibuprofen was still available for them to pick.

Quite remarkably, what happens is that the attractiveness of oral medication drops when a second option is added. Why? Because doctors find it very difficult to differentiate between Ibuprofen and Piroxicam - the 2 drugs are similar such that it doesn't seem to make sense to pick one over the other. 
So what do these conflicted doctors do? They choose to avoid the question. Instead of picking between 2 similar drugs, they went with the third option - hip replacement surgery.


This turns on its head that more choice is better. Sometimes when the choices that are available are too close to each other, it leads to decision paralysis. Instead of finding it easier to make a better decision, we find it difficult to even make a decision in the first place - we become paralysed. Additional choices similar to one another reduces the attractiveness of these choices.  And this applies even to experts: even doctors struggle to make difficult decisions.


Even more interesting would be if we asked the doctors in group 2 why they had picked surgery. Imagine what their answers would be. Probably that surgery is the right choice. Yet if the same doctors were put in group 1, some of these doctors would change their decision, purely based upon the number of options available.

The patient does not change. The only difference between the 2 groups is that 1 additional option of pain management pills. 

And this case is one of many examples of how we are subconsciously influenced by many factors. By definition, we don't know we are being influenced. Yet, no matter what decision we make, we can always find reasons to justify ourselves. Are these reasons really true? How do we know they are true? Which doctor would have noticed and admitted that he/she picked surgery because he/she couldn't decide between the 2 types of medication?


What other examples?

- How you gauge personality is influenced by the temperature of the cup you are holding

- What choice you make depends on what is the default option

- How much you like or love something (including your spouse!) can change just by the phrasing of the question

- You become more generous after going through a superhero simulation

- Fish tastes better with a different name

We want to think that we are purposeful, that we don't do things without a reason. But do we actually reason what we do instead?

This experiment bears a close resemblance to a classic philosophical problem  - what is termed Buridan's Donkey. A donkey is equally hungry and thirsty and is placed exactly midway between a stack of hay and a bucket of water. The donkey is unable to decide whether to satisfy its thirst or hunger first and eventually, it makes no decision and dies. (there're various permutations - in another, a hungry donkey is placed between 2 identical piles of hay, and, unable to make up its mind one again, dies of hunger).

Buridan's Donkey served as a hypothetical image for a debate on free will. But it's not a very good debate, and the main takeaway for us is, difficult choices make people freeze, tend towards the default or the safest choice, a characteristic that has been observed since the time of Aristotle in ancient Greece. 

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