Do the Right Thing

In 1588, the English dramatist John Lyly per, in his ‘Euphues and his England’, wrote: “…as neere is Fancie to Beautie, as the pricke to the Rose, as the stalke to the rynde, as the earth to the roote.” By 1741 Benjamin Franklin, in ‘Poor Richard’s Almanack, this had simplfied to: “Beauty, like supreme dominion is but supported by opinion.” Today we just say that “beauty is in the eye of the beholder.”

I have no case to doubt any of these observations. In fact, I would go further and say that almost everything is in the ‘eye of the beholder.’ That means we react to things as we see them and not necessarily either how they are or how others see them. This understanding is vital if we are to fully understand the biggest problem in Healthcare today. To put it in the terms of Jazz musicians Melvin “Sy” Oliver and James “Trummy” Young, “T’ain’t What You Do (It’s the Way That You Do It).

Thinking and acting

The first thing we all need to come to terms with is that thinking does not cause action! At first this might seem like a shocking idea to comprehend. Surely, we have been taught for years under a psychological model, that actions arise out of our thinking. Clearly they often do but often, they do not. How many times have you told yourself to do something and then not done it? With me, often, I tell myself not to do something and then do it anyway (see Krispy Kreme donuts).

So, if thinking does not always cause action, is there something that does?

Well, yes there is, according to the book, “The Three Laws of Performance: Rewriting the Future of Your Organization and Your Life” by Steve Zaffron and Dave Logan. Per the first of the three laws, how people perform correlates to how situations occur to them.  In other words, people do what they do because of how they see the situation in front of them, or as Zaffron and Logan put it, “how it occurs to them.” Moreover, this model works 100% of the time.

One of the significant implications is that people don’t do things because of the way you see them, they do them because of the way they see them. So, while I might think of something as ‘obvious’, if it doesn’t occur to someone else the same way, they may not react the way I think they should. Before we explore how this is effecting healthcare, let us spend a moment on how we end up seeing the world the way it occurs to us.

Perception and Reality

The way things occur to us comes from many different sources, but at the heart of them all is how we learn things. Learning, in a ‘school’ sense, is often about reading and understanding – it’s a very traditional or linear approach to getting knowledge. In our real lives, we tend to learn non-linearly. We learn by experiencing things. For instance, if I want to learn to ride a bike, a book can only get me so far. At some point, I need to get on it and try to peddle. This non-linear, or experience based approach, has the biggest influence on ‘how things occur to us.’

There is not enough room in this blog, nor am I skilled sufficiently, to fully argue this out. If you want to understand this approach better, try Zaffron and Logan’s book or check out our recently published Whitepaper called ‘A Non- Linear Approach to Patient Behavior” and you can find it there. For the moment, let’s assume that how something ‘occurs’ to someone is the primary motivator as to how they respond to it, and, further,  that they came upon that perception through a set of experiences that were non-linear.

Occurring in the Medical World

Having accepted this assumption – let us look at the most obvious way it effects healthcare in the US.

Let us, for this example, say that you have just been diagnosed with Type II Diabetes. Your doctor will give you a considerable amount of information to read, prescribe medication, tell you what you can and cannot eat, and probably even tell you that you need to do more exercise. The fact is, after receiving this advice, you will have taken less than 50% of the drugs you have been prescribed, and you probably tried to follow the dietary and exercise plans that have been suggested, but have slacked off there, too.

So why is that?

Well, to start with, in the 15 minutes the Doctor spent with you, he or she were trying to pass on knowledge that took them, a dietician and physiotherapist collectively 20 years to learn and understand. Add into this, everyone you meet has lots of input on what you should and should not do. As Sue* (*not her real name), who was one of the participants in the first Clinical Trial of the Wellsmith solution for Type II Diabetes said to us, “I was overwhelmed and confused. Everywhere you looked and everyone you talked to had their own advice. It was very hard and confusing.”

The problem is that for most people, the way the diabetes ‘occurs’ to your doctor is not the same way as it ‘occurs’ to the patient. For instance, to the doctor Type II diabetes is a combination of physiological, behavioral and lifestyle issues working together to change the chemistry of the patient. To the patient, diabetes, maybe just be another thing to try a juggle in an already complex and busy life. For the patient who has been diagnosed with diabetes but doesn’t necessarily feel that ‘ill’, it may just be something to worry about later.

A doctor, while maybe resigned to this response, would of course point out that long term, not managing your diabetes maybe cause other significant problems. The patient might point out that long-term is a long-way off and may not be something that occurs as a high priority. Think that unlikely? Well if you do, why do so many people still smoke when they probably know the consequences of the habit? The way these things occur to people will directly effect the way they respond to them.

Multiplication Effects

Given how complex it is for any one of us to get our brains around having a Chronic Disease, like Type II Diabetes, imagine what happens when you have 2 or more. Add a diagnosis of Chronic Obstructive Pulmonary Disease, or COPD as it is often called. For some, COPD goes together with Heart Disease and Congestive Heart Failure. If you can’t manage your life with Diabetes, how does diabetes + COPD + CHF ‘occur’ to you?

Well, for many, it occurs as too hard to deal with and is ignored. While some would claim this to be denial or stupidity, it is how many deal with this sort of news. They continue to eat badly, drink too much and even smoke. This complexity can be made worse by the way their health provider responds. Multiple different conditions can mean multiple different doctors and complex care plans to fix their specific problems. For a patient already confused or lost in the diagnoses – complexity is best managed by ignoring it.

But there may be an answer in understanding this approach from the point of view of the patient and not the medical provider. Rather than thinking about the horrific downsides of not following sound medical advice, we should consider how all this occurs to the patient. If it seems complex, confusing and hard to follow, then we need to make it simple, memorable and actionable.

Things that are simple, memorable and actionable are easy to do. They become instinctual or habit, like brushing your teeth. If you can achieve this, then the instructions from a healthcare professional will not see like a mission impossible or a death sentence.

This is what Wellsmith has done.

It has taken the complex, confusing and hard to understand and made it simple, memorable and actionable. It is reducing the impact of Chronic Diseases like diabetes by changing the way diseases and their control over it occurs to those that suffer from it.

So, what’s the magic?

Keep an eye out for my next blog. All, as they say, will be revealed.