What if I told you that we, as a nation, waste $317 billion a year in medical expenses just because of forgetfulness and procrastination? Research from Express Scripts, a pharmacy benefit manager, shows that the biggest healthcare issue facing the nation today is not illnesses related to smoking, excessive drinking or obesity due to overindulgence in bacon cheeseburgers, super-sized sodas and curly fries. No! It is what the healthcare industry calls “non-adherence” – not taking our medications as prescribed by the doctor, following guidelines and sticking to our promises to take better care of ourselves in general.
We all know the importance of diet and exercise. Yet, often times we just think up some lame excuse. My husband, for example, won’t eat dark, leafy greens as he claims he’s got supersensitive papillae on this tongue and therefore they taste way too bitter. And a friend of mine won’t get on what she terms the “Dread-mill,” even now in NYC when it’s too icy to walk outside, because she knew someone who caught her foot in the belt when it was moving and fell off. (Truth be told, I feel the same way about the “H-elliptical” machine!)
And how many people do all of us know who don’t sign up for a 401K even when it means they are losing out on the match made by their employer, just because they never “get around to it?” Voila! Procrastination at work!
Getting everyone to regularly focus on their health-related behaviors is the best method for combating issues ranging from obesity to missed doses of important maintenance medications. While the approach may be appealing, unfortunately, it may run headlong against millions of years of evolution. According to Bob Nease, Ph.D., Chief Scientist at Express Scripts, “Our brains, though amazing machines, simply are not made for continuous focus on anything that isn’t immediately painful or pleasurable. The gray matter in our heads can process about 10 million bits of information a second — the same bandwidth of the original Ethernet cable. Yet the conscious part, which we think of as our mind, can only process 50 bits every second. We are wired for inattention.” (Yikes! That’s a thousand times slower than dial-up!)
Ergo, the intent-behavior gap, which explains why we behave in ways detrimental to our health, despite our best intentions to do otherwise.
Nease cites Adam Davidson, who writes the weekly “It’s the Economy” column for The New York Times Magazine, as an example. Apparently, after a lifetime of trying and failing to lose weight, Davidson recently succeeded by committing to a program that left him no options. “Most diets and other good intentions fail because there’s always a third option — an easy way out — that allows us to tell ourselves we tried even while undermining our own success,” he explains. “And when we make a firm commitment that eliminates these escape routes, we are more likely to get results.”
According to Nease, there’s a concept known to behavioral science as ‘precommitment.’ The idea, in fact, was first documented as far back as the 8th Century BC. “In Homer’s Odyssey, Odysseus needed to sail his ship past the Sirens, who’s enchanting song tempted sailors to their deaths. So before entering those waters, he lashed himself to the ship’s mast so he could resist. His precommitment helped him stay the course.”
Nease contends, however, that he has yet to hear of a diet guru taking Odysseus’ approach literally –e.g., lashing our arms to the dining-room chair. “But some companies are working to make it easier for people to impose big financial penalties on themselves if they fail to meet their weight-loss goals. And precommitment strategies in the tradition of Odysseus propose a good way to navigate through modern life’s multitude of options and temptations to arrive at a healthier place.”
For their part, Express Scripts discovered, for example, that offering their employees the opportunity to precommit nearly tripled actual participation in a company exercise program. “If they agreed in advance to let us block the time on their calendar,” Nease insists, “they ultimately overcame the day-of excuses, showed up, and got in some good exercise.”
The real costs, both financially and heath-wise, come from non-adherence to taking prescribed medications. Forgetting to take a heart pill, for instance, could endanger your life. My husband must take the anti-blood clotting medicine Plavix thanks to his three coronary stents (hellooo filet mignons!!). His cardiologist doesn’t want him to miss even a single dose as that could mean a heart clog and possible death. (He always hides his pills when we have an argument, fearing that I will switch them for a placebo!)
Discipline and willpower are the simple answers, but remember what Bob Nease said about our being wired for inattention and inertia? Below are some simple pre-commitment techniques, starting with the ones I recommend to my audience:
• Use only smaller plates and eat in a room outside the kitchen, away from the refrigerator.
• Eliminate leftovers by buying food and preparing dishes in smaller quantities.
• Banish snack foods from the house. You can’t eat what you can’t find.
• If you’re a late riser, put the alarm clock across the room to avoid simply reaching over and swatting the Snooze — or worse, Off – button.
To precommit to your medications, I defer to Bob Nease:
• Tape a note to your refrigerator or set an alarm that will help make taking your pills part of your daily routine.
• Having your prescriptions delivered to your home in 90-day supplies has been proven to increase adherence.
• Check your prescription insurance plan to see if automatic refill reminders are available and how you can sign up to receive them.
• Long before you near the end of your final refill, schedule an appointment with your physician to renew the prescription. If you wait until the last minute, you might not be able to get there in time to stay on your therapy.
• Take advantage of being able to ‘opt out’ if your automatic enrollment gives you the choice. This approach leverages inertia – the opposite of patient engagement — by making you do something to stop the delivery.
No matter what method you use to pre-commit to all aspects of your personal wellbeing, remember that better decisions today lead to healthier results tomorrow. In other words, to feeling Better Than Before.