Why I keep on getting parking tickets and you can’t seem to take your drugs
Arriving home the other day I noticed that on the table,
together with the other letters, was an open envelope containing a penalty
charge notice….
“What is this?” I asked, shocked.
My husband looked at me and said “You got another fine for
entering and stopping on a box junction, will you ever learn not to do it?”
The truth is that we are all able to understand the
implications of our behaviour. We know that certain acts will have certain consequences.
And we have this in the back of our minds.
Yet why do we keep on making the same mistakes? Why is it
that we ignore the warning signal? Or in other words; why does our brain fail
to learn from previous experience without allowing this cause-effect chain to positively
guide our behaviour, for better outcomes?
I think these questions are very much related to what happens
when patients fail to comply with their treatment regimes.
We are extremely capable of assessing immediate threats.
It’s something we are hardwired to do. But our brain, to a certain extent, is less
skilled at assessing more long term risks. When we assess long term
possibilities we get clumsy. We somehow dismiss the possibility of not getting
over our sickness or injury and often overestimate our capacity to overcome symptoms
even with irregular compliance to treatments.
It seems so straight forward that if you are sick, the only
way to get better is by following the treatment that the doctor has suggested.
And yet there are many articles, papers and research examining why patients
struggle to comply with their medication regimes.
So why doesn’t the patient comply?
There are many theories to explain this. For example, some
patients have illnesses where symptoms do not get in the way of everyday life,
so it is easy to ignore the illness and hence the treatment. This is the Denial theory.
The cost of the treatment could also somehow explain why the
patient does not comply, specifically in cases where the treatment is very
expensive for the patient and no insurance company willing to cover that cost. For
me, this reason only explains why the patient does not buy the treatment rather
than why he refuses to follow it.
In certain cases, complex treatment regimens are a critical reason
for noncompliance. They might be too difficult for a patient to follow, especially
if we take into account the age and also if the patient have multiple conditions
at once. I would justify that this is a reason for overdose or wrong
compliance. This could be fatal, so establishing clear instruction is a must
for the doctor. However, nowadays this can be overcome and treatments
simplified for the patient making them easier to follow.
Others reasons might be related to the side-effect profile of
the treatment; the flavour of the medicine; or even the lack of trust in the
drugs. In the short term, this can explain why some people push back the time
of taking their medicine or find a quick way out to avoid taking it completely.
I have observed this often with my children. If they do not
“like” the flavour of a certain drug, they will try to negotiate the amount
they ingest or attempt to avoid it all together. In turn this increases the
likelihood that I will give up as soon as I see there is a certain improvement
in their symptoms.
Don’t get me wrong, I am sure that some cases of
non-compliance have a simple explanation. And we should always identify
individual differences. However, I am going one step beyond these traditional
theories to discuss non-compliance in terms of the subliminal human mind.
I’ve already mentioned that we do not evaluate risk in the
short term the same way we evaluate risks in the long term. To put this into
context, we are often more aware of the weather issues that can ruin our flight
arrangements when we go on holiday than the need to recycle more to reduce the
long term impact of climate change.
Early approaches in Psychology assumed that individuals behave in a rational manner, weighing
information before making a decision. So, the more information you have the
more likely you will accurately assess risk and hence the higher the
probability you will act accordingly. In our case, the more you know about your
drug and illness the more you will comply with your treatment. However, this
approach is not the entire story. Evidence has shown that the possession of
additional information alone, won’t shift perceptions. So, we need to
understand what factors influence how individuals assess the information they
are presented with - not an easy task!
And I have not yet
talked about something that is becoming increasingly important in the field of
behavioural economics; our emotions. Specifically, what feelings are associated
with an individual’s experiences and how do these feelings guide their
behaviour?
Emotions can be positive
or negative, so if we associate a negative emotion with a consequence we may
avoid that outcome by not pursuing it. So, a positive feeling about something will
increment the probability that we repeat an action. However, even this theory has proven to be
missing pieces of the puzzle.
Research has
shown that risk perception is highly dependent on intuition and experimental
thinking as well as emotions. In
summary, it seems that we evaluate our environment in a rather non-rational
way.
So going back to
my initial questions; why I do keep collecting parking tickets, why does a
patient not comply with his medication, and why we do we not do anything to
avoid the dangers of climate change?
I think we assess
the future in a rather blurred way and only act in the immediate present. This
is a basic survival instinct, and as a result we fail to link our actions today
with a potential negative outcome of tomorrow and understanding how maladaptive
our behaviour can be.
What does this
mean? Well, we like to take our chances, or at least I do!
This article was
written by Ana Puglisi in our UK office.
