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Sharing the 'chimp' and its effect on decision-making

Pharma needs to learn how to dial up its emotional connectivity
the Chimp

Rational thinking often dominates much of what we do in pharma. We are comfortable with making decisions based on evidence, with a plan that can be rationally explained and produces predictable outcomes. We produce marketing materials overflowing with graphs and data, and interactive resources jam-packed with hyperlinks to yet more research - all designed to provide a persuasive, logical rationale for prescribing product X over product Y.

Yet the world is not full of rational people. We all make decisions based on a mixture of rational and emotional factors. Estate agents know this only too well. That is the reason they send you endless houses which never match the list of criteria that you told them you were looking for  - because they know that the three bedrooms, large garden and a garage can all be thrown out if you form a rapid emotional connection to a property.

Not surprisingly then, physicians and patients are no different in this context which means that we are having to learn rapidly how to dial up the emotional connectivity.

Seeking the 'Golden Ticket'

Particularly in the area of adherence, getting to grips with why patients make decisions is vital if we are to tackle what is arguably one of the biggest problems facing our industry. WHO figures suggest that over 50% of people with long-term health conditions are non-compliant with their medication regime within 6 months.

With spiralling healthcare costs, it is hardly surprising that budget holders are looking for the 'golden ticket' that delivers adherence and with it the health outcomes that governments and payers want to justify the cost of treatment.

The drive to achieve better adherence has led to a vast expansion in patient support programmes, growing in their sophistication. The simple patient leaflet has disappeared, replaced by suites of resources, digital apps, websites, videos etc. 

Different methodologies for activating patients are evolving, supported by published literature, and strong academic research. Some people respond well to these programmes, often the better-educated, demanding patients. 

Yet the challenges remain: a substantial population remain difficult to reach and hard to engage in their health. One of the most perceptive works looking into human behaviours is The Chimp Paradox, by Prof Steve Peters. This acclaimed book introduces the concept of the 'Chimp' in all of our brains, and the effect it has on our decision-making and behaviour.

 “The Chimp does not necessarily work with facts, but it works with what it believes is the truth, or with a perception of the truth  - or even worse, with a projection of what might be the truth.”

The Chimp Paradox, Prof Steve Peters.

Understanding the Chimp

Human behaviours are challenging, as Peters illustrates with great clarity in his book. Drawing on his decades of experience with sporting celebrities, many of whom have reputations built on the back of doing 'illogical' things in a very public setting, Peters introduces us to his 'Chimp Management' model.

He defines the frontal, limbic and parietal brain as the Human, the Chimp and the Computer: 

  • the Human thinks calmly and rationally, searching for facts to establish the truth
  • the Chimp is the emotion machine; it thinks independently, can make decisions, can be constructive or destructive; it deals with feelings and impressions
  • the Computer stores information; is based on learnt behaviours, learnt beliefs and automatic programmes; the Chimp and the Human input into the Computer. 

According to Peters, the Human and the Chimp have independent personalities, ways of thinking and modes of operating, and he gives powerful illustrations of how the Chimp overpowers the Human. This is the reason why, he says, people say things in the heat of the moment and regret them, eat a whole bar of chocolate despite thinking they will have only one square, or don't exercise when they want to.

Humans are more likely to work with evidence-based thinking, are rational, and with balanced judgment. In contrast, Chimps jump to an opinion and think in black and white. They are paranoid and need to feel safe; they are insecure, so they may read lots of things into harmless situations; they are irrational, constantly vigilant to danger, catastrophic and make emotive judgements.

Sharing approach

So what if we took this powerful model and examined it through the lens of healthcare? There are certainly applications in the context of important evolving care models like shared decision-making and the broader context of self care and self management.

In the Royal Pharmaceutical Society's excellent report Involvement, Shared Decision-Making and Medicines, the complexity of involving patients in treatment decisions through the lens of prescribed medicines and their use is well explored.

It concludes that some of the challenges are around:

  • Clarity on the purposes and agendas being pursued in the area of medicines and patient and involvement
  • The gap between policy and ideal and routine practice
  • And, how policy requires a 'transformative, zeal of patient involvement and shared decision-making'.

In a similar vein, the Health Foundation's report Implementing Shared Decision Making looked at some of the ways patients and physicians can make a contribution together, looking at wider objectives, incentivising staff, and importantly 'activating' patients. There are some brilliant ideas and learnings collected here.

Addressing the Chimp

“Sometimes emotions are very irrational, and you have to work with them rather than constantly trying to understand them,” explains The Chimp Paradox.

But, what if we look at Prof Peters' model in the context of mind management and the challenges of self care, starting with shared decision-making, where physicians and patients unite to develop a treatment plan based on evidence, facts and data, evaluating risks, options and outcomes? This fact-based approach would draw on Peters' 'Human' and 'Computer'.

But if, as he contends, all information goes to the Chimp first - who then decides if there is anything to worry about  - this approach may risk allowing the Chimp, which thinks faster and is more dominant and illogical, to make decisions based on a more emotional reaction.

Couple this likelihood with the learned behaviours people bring with them as they approach health, and you can see that complexities abound. Our nice, neat, fact- and evidence-based decision-making can be undermined easily, leading to irrational and unpredictable choices.

Similarly in the context of self care or patient support programmes, a person's own Chimp may actively disrupt his ability to make the changes he wants to, or prevent him from actively tapping into the wealth of resources that are available to support him.

Managing the Chimp

“A chimpanzee is five times as strong as a human being. Similarly, your emotional Chimp is five times stronger than you are. Don't try to control it, manage it. You need a management plan!” says The Chimp Paradox.

By helping us to understand our inner Chimp, Peters seeks to help us harness its power and neutralise it when it is not constructive. He contends that even though our Chimp exerts a powerful emotional pull on us, we can and must manage it.

The Chimp needs less than 10 minutes to express itself

A crucial step in doing this is to accept that the fundamental drivers of the Chimp will not change; it is an emotional machine that is never going to be programmed differently. It will, according to Peters, 'always act on drives and according to its nature, with emotions and actions such as aggression, neurosis or impulsivity'.

So if you can't remove those drivers, or battle the Chimp with willpower, how can we manage it in patients? It is about accepting and working with those drivers, managing those emotions and impulses by recognising what the Chimp needs and how it works - allowing people's Chimps to release their emotions and opinions  - only then will they listen to reasoned argument.

Peters suggests that for most people, the Chimp needs less than ten minutes to express itself, before it will let the Human side of us select the sensible, rational choices. But if it not given the chance to do so, it will dominate, and drive the person to make an irrational, illogical choice (a process he calls 'Boxing the Chimp').

Language is an important aspect in this, and one which the pharma marketer does have some control over. Peters talks about the difference between 'should' and 'could', as in 'you should manage your condition better' or 'you could manage your condition better'.

The first evokes a sense of judgement, a command, a feeling of guilt or potentially failure; the second evokes feelings of possibility, an option, a choice, empowerment, a potential for change. When it comes to persuading patients to change their behaviour, a simple choice of language like this can have a profound effect.

Say Hello to Barry

In such a limited space, I haven't done full justice to Prof Peters' work, and encourage you to read it  - or hear him speak, as he is fantastically engaging presenter. However, there is much we could learn from his mind management techniques and apply to healthcare.

He also strongly recommends that we get to know our own Chimp, even giving him a name. So I've adopted this philosophy; my Chimp is called Barry. And sharing Barry - and all our customers' Chimps - just could help us understand the emotion behind decision-making and behaviour change.

Article by
Jane Ayton

is CEO of Cello Health Communications Europe. She can be contacted at jayton@cellohealth.com

26th January 2015

From: Marketing

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