Illusion of Choice in Healthcare


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Blog by Joe Babaian

The illusion of choice is the greatest magic trick ever performed.

― Ziad K. Abdelnour

The idea of free will and the meaning of choice have been a philosophical discussion since the beginning of spoken language. I’d like to focus on something a bit less esoteric – choice or the illusion of choice in healthcare. Far from me telling you that you really do or do not have a choice, I want to open the discussion to an evidence-based answer. All of you, great #hcldr participants and readers, are the best examples of what is real, right now and in your experiences. Nothing is more valuable than that.

In healthcare, the comparisons to consumer models are popular. We’ve discussed the similarities and differences, we’ve looked at how forced choices are not really choices at all. My #hcldr partner Colin Hung made a comment that sticks with me,

A forced consumer is not really a consumer.

This statement underlines the essence of this week’s topic and asks us, “Is choice an illusion in healthcare – and does the answer differ for certain populations?” Further, do we need full choice in a healthy healthcare system (suspend your disbelief here for a moment)? Are we content to settle for a less-than-ideal path but one that nevertheless provides an acceptable level of care?

Through the lens of the industrial age and its clear influence on our entire healthcare system, has the value of standardization gone too far – taking the human element out of healthcare? Perhaps we agree, one size doesn’t fit all even as our many clinicians and staff members operate in a system designed for standardization. The lessons on speed and efficiency are part and parcel of standard medical education. We’ve familiar with the famous quote by Henry Ford,

Any customer can have a car painted any color that he wants so long as it is black.

Is it time to divorce healthcare from the 20th-century lessons and dogma on standardization?

Today, let’s share our experiences on choice in healthcare. With #DigitalHealth growing and improved #AI tools within reach, we need to assure these technologies enhance the ability of healthcare to be personal vs just another way of speeding things up.

Please join the #hcldr community of friends and peers as we work to make a difference, one idea and one action at a time. Join us on Tuesday, October 23, 2018 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:

  • T1: Is choice an illusion in healthcare? Why or why not? Examples?

  • T2: With high healthcare utilization, can medicine be truly personal or will efficiency/standardization be primary?

  • T3: Can technology be used to increase choice/access for underserved populations? What obstacles are found here? Examples?

  • T4: Besides technological advances, what other things will increase choice and personalization in healthcare?


Resources for Further Study

Annas, Georges. “The Illusion of Choice in Patient Power.” Nature 390, no. 6656 (November 13, 1997): 133–34. doi:10.1038/36487.

Bloomberg. “Ziad K. Abdelnour: Executive Profile & Biography – Bloomberg.” Accessed May 29, 2017.

Desjardins, Jeff. “This Infographic Shows How Consumers Only Have ‘the Illusion of Choice.’” Business Insider, July 23, 2016.

Frost, Dennis. “The Illusion of Choice and Decision Making in Dementia Care.” Criterion Conferences, March 3, 2017.

Lammers, Stephen E., and Allen Verhey, eds. On Moral Medicine: Theological Perspectives in Medical Ethics. 2 Sub edition. Grand Rapids, Mich: Wm. B. Eerdmans Publishing Co., 1998.

MacKinnon, Matthew. “Illusion of Choice: The Myth of Free Will.” Psychology Today, August 28, 2016.

Macknik, Stephen L., Susana Martinez-Conde. “When Free Choice Is an Illusion.” Scientific American, January 1, 2017.

Willis, Karen, and Kirsten Harley. “Private Health Insurance and the Illusion of Choice.” The Conversation, February 6, 2013.

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Illusion of Choice in Healthcare