The 5-Minute Shower

If you live in California, suffering through its worst drought in history, you are probably trying to do your part by taking shorter showers. Gov. Jerry Brown says it should not last longer than 5 minutes. You will probably not stop watering your lawn or install low volume toilets, which are acutually much more effective ways to save water. I mean, there are limits.

If you are a doctor, according to our new medical laureate, Atul Gawande,you are probably ordering all kinds of tests, treatments and procedures that are worthless , wasteful and harmful. There are many reasons why, including fear of lawsuits, greed, a genuine belief that you are doing what’s best for the patient, ignorance about state of the art recommendations, and lots more. There are many, many reasons why doctors make technology adoption errors.

Getting people to do what they are “supposed to do” is the last mile when it comes to altering our sick care system. Every participant, whether it’s the payers, the doctors, the patients, or industry, seem to have a hard time doing the right thing.

Strategies to change habits abound. Results are few.

We’ve learned a lot about the anatomy and physiology of habits. It has something to do with your basal ganglia and triggers, responses and rewards that get hard wired. That’s part of the reason why habits are so hard to change.

The strategy de jour usually involves some permutation of the following steps:

1. Information and awareness. Create campaigns, commericals, blogs, articles and social media campaigns trumpeting the evils of your given poison, whether it be fat, sugar, salt, too much water, CT scans for back pain or e-cigs.

2. Tools. Put a brick in your toilet. Give doctors choices in the EMR or decision support software when it comes to ordering tests. Make sure every patient who is overweight has a Lose It! app on their iPhone. Here’s how to take a Navy shower.

3. Incentives. There are two basic categories. depending on whether you live in a blue state or a red state. Blue states favor the heavy hand with lots of rules, regulations and oversight. Red states like the invisible hand offering market based solutions.

4. Stealth. Also known as the NSA strategy, the behavior changers bring to bear all the tricks and tools of modifying, managing and monitoring consumer behavior without us saps even knowing about what’s happening. They hope we’ll just do what we are supposed to do like a trained animal.

5. Appeal to our inner goodness or not so pretty foibles. Take one for the team. Your kids will thank you for saving the planet and care being there when they need it. After all, everyone else is doing it.

By the time you have read this on your iPad in the shower, you have already exceeded the five minute limit. Your violation will be posted on Facebook. Fortunately for you, we’ve held off posting the shower videos on You Tube, but we reserve the right to use all available remedies at our disposal.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at