This session continues the theme of empathy and decision-making. In the last session, we learned that doctors make different choices on behalf of patients than they would make for themselves. In this session, we'll go a few steps further and address whether this is unique to doctors or extends to everyone. More importantly, why does this occur? Before we start, it's important to note that we're not arguing that physicians were making worse choices for patients than for themselves. Just that the choices were different. Like many real-world scenarios, there was no better choice in the medical scenarios that the doctors read. The fact that the choices were different is enough to raise concern though. Because what's best for the patient depends not only on the details of the patient's health and condition, but also on the patient's values. Making the best decision requires some insight into what the patient wants. Some people want to live no matter what. Some people want to minimize suffering no matter what, and so on. Neither preference is right or wrong, it's just right or wrong for that person. Recommendations should reflect the patient's values. With this in mind, let's talk about the why. There are several possibilities. One of the explanations offered by the researchers is that doctors are susceptible to psychological biases just like the rest of us. One of these biases is called omission bias, which is the tendency to believe that harm resulting from an action is worse than the same harm resulting from an inaction. In other words, doctors may have been tempted to forgo the treatment simply because people believed not acting is inherently less harmful than acting. Research several years later suggests that this explanation has some credibility. A researcher proposed that deciding for someone else versus yourself changes a person's regulatory focus. Which means that it changes the way a person goes about achieving their goals. Deciding for yourself involves a prevention focus, a defensive mentality focused on minimizing bad outcomes. Deciding for someone else involves a promotion focus, an aspirational mentality focused on maximizing good outcomes. A good analogy is sports. To win a game you need both offense, and defense. Regulatory focus is just about how much emphasis you're placing on offense and defense as you try to win the game. For doctors, the goal is choosing a treatment. The theory goes that doctors choosing for themselves were more focused on avoiding a mistake. While doctors choosing for patients were more focused on picking the right treatment. To provide evidence, several studies place people in one of two scenarios, deciding for themselves versus deciding for others. Then the study is varied other aspects of the decision to see how much relative emphasis people place on avoiding a mistake versus finding the best answer. One big aspect of the decision is the number of options you have. A person motivated to avoid mistakes is likely to prefer a smaller number of options, because every extra option is another chance to make a mistake. On the flip side, a person seeking the best option is likely to prefer more options because every extra option is another chance for improvement. What happened in the studies? Are we possibly a little more focused on protecting ourselves than we are in protecting others? I'll highlight a couple of key things supporting the explanation we've developed. In one study, college students made a hypothetical choice for themselves or for someone else about which color to paint a bedroom offering eight colors, a few options, or 35 colors, a lot of options. Then asked, how satisfied people were with the choice that they made? People choosing for themselves were more satisfied when choosing among a smaller number of options whereas people choosing for others were more satisfied when choosing among a large number of options. A second study involved real choices by real people. Shopping for wine either for themselves or for someone else as a gift. Lucky friend. The questions asked, were either asked in a small store with few options, or a large store with a lot of options? Again, people shopping for themselves were more satisfied when choosing among a few options whereas people shopping for others were more satisfied when choosing among a lot of options. The differences don't stop there as the key is that we're more likely to be focused on avoiding mistakes than on finding the best answer when we decide for ourselves with all the good and bad consequences that come with it. In another study, this translates into more creativity when we decide for others. This occurred on three different creative tasks; Drawing a picture, generating new ideas, or solving a complicated insight problem. In a study that I ran with accounting professionals, increasing the focus on avoiding mistakes made accountants less willing to offer contrary views on a complex problem, and to offer less precise views. Again, these decisions aren't necessarily wrong, but they absolutely are made for the wrong reasons. It's possible that even if a doctor is primarily motivated to avoid mistakes, they might still choose the right treatment for the patient, but not always. A decision made for the wrong reasons could turn out to be right but a decision made for the right reasons is always right.