October 2004

Schedule appointments at check out for better compliance

Which gets better patient compliance: Scheduling patients for their next appointment as they check out or let them go home and schedule them with a follow-up call later?

Common sense may tell you to schedule your patients now for future appointments and a new study published in the October 15 issue of Science magazine confirms why your intuition is valid.

According to the study, people are often torn between impulsively choosing immediate rewards or more deliberatively planning for the future

The research, supported in part by the National Institute on Aging (NIA), a part of the National Institutes of Health (NIH), suggests that human decision-making is influenced by the interactions of two distinct systems in the brain. One system wants immediate gratification and the other can delay gratification. The systems are often at odds.

The finding has broad implications for predicting economic and behavioral health patterns, says Richard Suzman, PhD, associate director of the NIA's Behavioral and Social Research Program.

“This landmark study has the potential to reshape what we should look at as we try to understand how people make both health and economic decisions,” Suzman says. “Since many health and economic decisions involve choosing between short-term gratification and long-term delays of rewards, this approach and its finding are likely to have a significant impact on our ability to influence health and economic behaviors such as diet, exercise, and saving for retirement.”

For the study, a research team, which included NIA grantee David Laibson, PhD, of Harvard University and the National Bureau of Economic Research in Cambridge, Mass., asked 14 participants to choose between receiving money at an earlier or later date.

For instance, a participant might be asked to choose between receiving $27.10 today versus $31.25 in a month; or $27.10 in two weeks versus $31.25 in six weeks. As the participants made these choices, their brains were scanned using functional magnetic resonance imaging (fMRI). This imaging tool enables researchers to measure second-by-second brain function in thousands of specific brain regions.

When participants chose between incentives that included an immediate reward, fMRI scans indicated heightened activity in parts of the brain, such as the limbic system, that are associated with emotional decision making.

In contrast, deliberative and analytic regions of the brain, such as the prefrontal and parietal cortex, were activated by all decisions, even those that did not involve an immediate reward.

However, when participants resisted immediate rewards and instead chose delayed rewards, activity was particularly strong in these deliberative areas of the brain.

“Our research suggests that consumers have competing economic value systems. Our emotional brain has a hard time imaging the future, even though our logical brain clearly sees the future consequences of our current actions,” Laibson says. “Our emotion brain wants to max out the credit card, even though our logical brain knows we should save for retirement.”

What this means to chiropractors, Laibson told Chiropractic Economics, is that you should encourage your patients to make their next appointment as they check out.

You probably knew that already, but now science proves you correct.

Source: National Institute on Aging, www.nia.nih.gov; David Laibson, PhD, dlaibson@harvard.edu

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