Avoiding “Throat Tickle Avalanche”: The Psychology of Getting People to Visit the Doctor

Last week, Hillary Clinton said the following about the Affordable Care Act (ACA): “We finally have a path to universal healthcare… I don’t want to see us start over again with a contentious debate. I want us to defend and build on the ACA and improve it.” We need a few more years to evaluate the effectiveness of the ACA, but one thing is for sure: nearly 17 million people gained healthcare coverage over the past few years. However, will people actually use their new healthcare plan?

A classic RAND study showed that people were more willing to go to the doctor if they didn’t have to pay for it. More recently, a survey showed that two out of three Americans choose not to see their primary care provider even when they have a health concern. These studies point to one thing: the ACA can only be effective if people go to see their doctor.

How, then, do we get people to seek medical advice?

In one study by Peter Ditto, a professor with the University of California, Irvine, participants were presented with a description of a fake medical condition called “TAA deficiency.” The researchers used a coated test paper that supposedly changed color in response to the absence of TAA in saliva. Study participants who were identified as being deficient in TAA were told they were at risk for developing pancreatic disorders later in life.

Consistent with past findings, participants who received unhealthy results rated their diagnosis as less accurate. Also, people who received bad news took longer to decide whether the results were complete and were more likely to request a retest. Dr. Ditto argues that people have a motivational bias that causes them to examine information consistent with a preferred outcome less critically than information that is inconsistent with a preferred outcome.  

In the context of health and medicine, I call this denial “Throat Tickle Avalanche.” Most of us have experienced the ominous throat tickle that occurs just before a full-blown sickness. When we feel that initial throat tickle, it’s easy to believe that it's due to something we ate or our allergies acting up (despite it being the middle of January with no pollen or other allergens in sight). We don’t want to get sick and have to miss work or spend the weekend in bed, so we convince ourselves that we’re fine. But that’s when the avalanche of sickness begins.

Take chest pains. Every year, a large number of people experience chest pain but they deny the possibility that anything is wrong and do not see their doctor. The effect of Throat Tickle Avalanche is a prime reason why one out of every four Americans dies of heart disease.   

One way to combat this effect is to make people more aware of their biases. Most people aren’t aware that they deny the truth about medical information and risk. In fact, people who experience pain are motivated to ignore their symptoms and often seek confirmation that they are, in fact, healthy. 

The advent of the Internet has made it incredibly easy to make a favorable “self-diagnosis.” In addition to the fact that a lot of online medical information can be misleading or inaccurate, Dr. Ditto’s work shows that people are biased to think everything is ok even when something may be seriously wrong. By understanding this fundamental feature of human psychology — that people are wired to view their health in an overly favorable manner — we can design tools and systems that ensure the success of the ACA.  

So, the next time you feel a tickle in your throat, pain in your chest, or some other discomfort, keep in mind how Throat Tickle Avalanche may affect your decisions. Healthcare coverage is only effective when you’re willing to have an open, honest exchange with your doctor.

Sean Young PhD

UCLA Center for Digital Behavior, Medical Plaza, Los Angeles, CA, 90024, United States

Sean Young, PhD, MS is the Executive Director of the UCLA Center for Digital Behavior. I'm a scientist, innovator, and UCLA medical school professor. I study the science behind human digital behavior (see digitalbehavior.ucla.edu for more info about this field of research).I also assemble technology teams and solutions to improve UCLA Family Medicine patient care. For more info or to contact me: www.SeanYoungPhD.com