Boundedly rational patients? Part 1: Health and patient mistakes in a behavioral framework

During medical visits, the stakes are high for many patients, who are put in a position to make, or to begin to make, important health-related decisions. But in such visits, patients often make cognitive errors. Traditionally, those errors are thought to result from poor communication with physicians; complicated subject matter; and patient anxiety. To date, measures to improve patient understanding and recall have had only modest effects. This paper reviews the current literature on behavioral insights in the patient experience and argues that an understanding of those cognitive errors can be improved by reference to a behavioral science framework, which distinguishes between a "System 1" mindset, in which patients are reliant on intuition and vulnerable to biases and imperfectly reliable heuristics, and a "System 2" mindset, which is reflective, slow, deliberative, and detailed-oriented.