Projection Bias in Medical Decision Making

however, my romantic misadventures had taught me that few people were as hooked on rationality as I was. More important, I had learned that you don’t get very far trying to make people more rational than they want to be. If we want to get people to change their behavior—and I am still persuaded that this can be a noble rather than a draconian ambition—we must develop the capacity to conceive what it “must be like” for them to think, feel, and behave the way they do. We must learn to see the world with their eyes and understand their values, motives, aims, categories, and concepts—an effort that may require us to at least temporarily suspend our most deep-seated assumptions about how they “should” behave. This too is no easy feat. But it is one that I am convinced the Society for Medical Decision-Making both must and can accomplish. From its inception 25 years ago, it has been committed to improving health and health care by showing people how to make rational use of medical knowledge. In a world with so many choices, and so much information to guide those choices, members of the Society have been leaders in developing and disseminating techniques for guiding health care decisions. They have set the standards in developing support tools—decision analyses and costeffective analyses—to help people maximize their health in the face of increasingly complex medical decisions. No single group of people is better equipped, therefore, to take the next step—namely, to incorporate into a model of decision-making the subtle but inevitable role that emotions play in the way that people arrive at decisions about their physical well-being. The 3 articles that follow, originally presented as talks at the Symposium on Emotions and Reason in Medical Decision Making, are ample evidence that the Society has already recognized and begun to address this challenge. Each, in their own way, illustrate how people’s decision-making processes do not match up to the standards that most of us champions of rationality might hope for. Like my ill-fated romantic experiences, the articles also illustrate that an exclusively rational approach, for all of its uses, may not be the one bestsuited to the matter at hand. In the 1st article, George Loewenstein discusses the ways in which people are influenced by the emotions of the moment, leading them to make radically different decisions depending on their mood. Loewenstein argues that, in effect, they become different people at different times. The 2nd article, by Norbert Schwarz, presents additional and compelling evidence of how people’s judgments and decisions are based not only on the information available to them, but also on their transitory moods and emotions. Schwarz’s research has momentous implications not only for showing how people think, but for demonstrating the challenges in collecting attitudinal information. The 3rd article, by Galen Bodenhausen, explores the role of stereotypes in decision-making. His article reminds us that decisions are not made in a cultural vacuum and that we need to consider not only the individual but also the social context of decision-making. Together, these 3 articles provide a firm scaffolding on which to construct a further and much-needed dialogue about the limits of rationality in understanding the decisions that people make about their health and their health care.