Sunday, 26 February 2017

Choosing Wisely: Sharks, Coconuts, Doctors and Chickens

Life is full of choices, and the choices we make are often deliberate, thought through, or based on emotion and can be instinctive, intuitive and unconscious. However, in some situations it is possible for others to deliberately manipulate the choices we make. This reflects the fact that the human psyche is pre-disposed to take a deviation and conflate it with the norm. It is the same cognitive bias that leads to some people not swimming in the sea in case they get attacked by sharks. This is despite the fact that there is a 300,000,000/1 chance of being attacked by a shark, compared to being hit and killed by a coconut (250,000,000/1). Around 150 people a year are killed by coconuts every year compared to around 40 people who are killed by sharks.

Psychologists have described the deliberate manipulation of our choices as an exploitation of the ‘availability heuristic’ (a term that once got me into all kinds of problems in the first year of becoming a Dean of School). In some ways the heuristic is a way we all make sense of the daily bombardment of information we increasingly having to face – if we didn’t we probably wouldn’t be able to cope with, and would be totally overwhelmed in having to deal with all that information. Making choices in a data and information rich world can be difficult. Occasionally we can end up making the wrong choice or feel we have no choice at all.  

Sometimes it can be easier to let others make the choice for us. Its arguably why people choose to go to A+E when a visit to their GP would be better. An informed choice might be doing nothing on the basis that the problem is likely to be self-limiting and probably not needing any medical intervention. At least 30% more time and resources could be freed up by people taking the latter course of action. And in the context of health care, it’s not just you and I that might make the wrong choice, the medical profession can also be guilty of choosing interventions that are unlikely to be of benefit. Sometime the decisions that health care professionals take can have more devastating consequences. It’s estimated there are 3790 avoidable deaths a year in the NHS – the equivalent of a jumbo jet crashing every week. Avoidable in that the deaths result from the actions or lack of action on the part of the health care professional.

The Office for National Statistics collects information on avoidable deaths in a slightly different way. Their statistics show that some 116,489 deaths in the UK were considered potentially avoidable had there been timely and effective health care or public health interventions available. They note (and the latest figures come from 2014) that people who die prematurely from avoidable causes, lose on average 23 years of life, which for children rises to 72 years of potential life. Chronic illnesses such as cancer and heart disease cause the largest number of avoidable deaths.

Choosing Wisely UK is part of a global initiative that seeks to ensure the notion of timely and effective decision making underpins patient centred care. The approach seeks to improve the conversations between patients and health care professional. Such conversations can lead to both the health care professional and the patient making better decisions about their care. The conversations are shaped around 5 questions: Do I really need this test, treatment or procedure? What are the risks or downsides? What are the possible side effects? Are their simpler, safer options? What will happen if I do nothing? The questions seem simple enough, and while they could lead to difficult conversations in some cases, they reflect the notion of ‘no decision about me, without me’. For my parents’ generation, it might have been true that the‘doctor knows best’, but that is not the case today. In the case of medical intervention just because something can be done doesn’t mean we always should do it.

And it appears that researchers in Sweden (well something has to happen there) have discovered how chickens choose wisely when it comes to mating. Researchers from Linkoping University found that hens with the largest comb gets the most attention from the cockerels. I know what you might be thinking but you are wrong. Larger combs correlate to denser bones. As the bone tissue provides calcium for the eggshells, the greater the bone mass, the more eggs she can lay, and the more attractive the hen becomes to the cockerel.

Finally, just thinking about deaths caused by sharks, coconuts or health care professionals, I can only find one case of a chicken ever killing a man. The man was one Jose Ochoe of California, a spectator at an illegal cockfight. He was stabbed in the leg by his fighting cockerel, who had a knife attached to its leg. He died 2 hours later.