My future daughter in law, Morgan, is a Board Certified Behavioral Analyst. She uses Applied Behavior Analysis to create interventions and plans that result in positive behavioral change. She’s thoughtful, intelligent, and great at her job. Behavioral change is a complex topic, and I have a lot to learn from her. Well before she was certified, though, Morgan was teaching me about my own behavior. It’s just that at the time, neither of us knew it.
One of the first few times Morgan joined our family for dinner, we went casual and ordered pizza. Not knowing her preference, we just ordered some supreme and some peperoni as those two choices cover a lot of bases. Without any complaints, Morgan took a couple slices of the pepperoni pizza. She delicately picked off the pepperoni slices and set them aside. Then she ate the remainder.
A couple of months later, we ordered pizza again. This time we made sure to order a plain cheese pizza that was specifically for Morgan. She was very kind and gracious as she always is, and she ate the cheese pizza instead of the supreme.
After about a year of this, it came up in conversation that Morgan prefers plain cheese on her pizza. She replied, “I actually prefer bacon, and sometimes meat lover’s.” When we finally got down to discussing it, she just didn’t like the veggies and mushrooms on a supreme. And as for why she picked off the pepperoni during that first meal, it was because she liked the taste that the pepperoni left on the pizza, but found the pepperoni slices themselves too greasy.
For a year, we had been making a decision for Morgan without ever discussing it with her. She just went with it because she just assumed we typically ordered plain cheese pizza, and between that and supreme, plain was her preference. We wouldn’t hesitate to order anything for her. We wanted her to have exactly what she wanted and the best that the pizza place has to offer. But she was always left with the plain results of my choice because she wasn’t involved in the choice.
The Opportunity Cost of Assumptions
I think back on my time as a clinic director and can easily point to times when I could have been better at not making choices for people. I assumed copays or deductibles were too expensive for patients to schedule three appointments per week. I assumed family obligations were too complicated to offer specific appointment times that patients would have preferred. I assumed they were too tired to push harder or, more often, that they were doing well enough to be done altogether.
In short, people ate cheese pizza because that’s what I served. There was a chance to sit down and say “Here’s what I think is the best. Knowing that, what do you think is best for you?” Then people could have been left to make an individual decision about their own care that was not only informed, but also one that worked for their individual priorities.
We shouldn’t be making assumptions about people’s preferences. We shouldn’t be making their financial decisions for them. We shouldn’t limit access to services we offer because of our biases. We provide an incredibly valuable service, but sometimes we’re the first in line to devalue it by making decisions for people who want to access that care.
Only our patients know their whole story. Morgan enjoyed the pizza she had and the time she spent with us at dinner. She would have likely enjoyed it more if she got to choose from everything the restaurant had to offer. She ate pizza that was less than it could have been because I decided what she wanted based on assumptions instead of collaboration.
This year, show your patients the whole menu. Don’t limit their experience to plain cheese. Don’t make their decisions for them. Give them all the information, then work with them to maximize that value.