Why it's so hard to make healthy decisions | David Asch

譯者: Yanyan Hong 審譯者: 潘 可儿

It's April of 2007,

2007 年 4 月，

and Jon Corzine, the Governor of New Jersey,

新澤西州的州長榮科讚

is in this horrific car accident.

出了嚴重的車禍。

當車在花園州公園大道撞毀時，

He's in the right front passenger seat of this SUV

when it crashes on the Garden State Parkway.

他正坐在這台休旅車 右前方的副駕駛位上，

He's transported to a New Jersey trauma center

他被送到新澤西的創傷中心，

with multiple broken bones and multiple lacerations.

全身多處骨折和撕裂傷。

He needs immediate surgery, seven units of blood,

他需要立即動手術， 輸了七單位的血，

a mechanical ventilator to help him breathe

還接上了呼吸器來輔助呼吸，

and several more operations along the way.

過程中又動了好幾次手術。

It's amazing he survived.

他能活下來真的很不可思議。

But perhaps even more amazing,

但，更不可思議的是，

he was not wearing a seat belt.

他沒有繫安全帶。

And, in fact, he never wore a seat belt,

事實上，他從來就不繫安全帶，

and the New Jersey state troopers who used to drive Governor Corzine around

以前負責幫科讚州長 開車的新澤西州州警

used to beg him to wear a seat belt,

曾經請求他繫上安全帶， 但他也沒有繫。

but he didn't do it.

Now, before Corzine was Governor of New Jersey,

科讚在當上新澤西州州長之前，

he was the US Senator from New Jersey,

他是新澤西州的美國參議員，

and before that, he was the CEO of Goldman Sachs,

再更之前，他是高盛公司的執行長，

responsible for taking Goldman Sachs public,

促成高盛公開上市，

making hundreds of millions of dollars.

賺了數億美金。

Now, no matter what you think of Jon Corzine politically

不論你對榮科讚在政治上 或在賺錢方式上有什麼看法，

or how he made his money,

nobody would say that he was stupid.

都沒有人會說他笨。

But there he was,

但，他卻是車禍中 沒有繫安全帶的乘客，

an unrestrained passenger in a car accident,

at a time when every American knows that seat belts save lives.

且在那個時代，每個美國人都知道

繫安全帶能拯救人命。

This single story reflects a fundamental weakness

這個故事反映出了 我們針對改善健康行為

in our approach to improving health behavior.

所採用的方法有一個根本的盲點。

Nearly everything we tell doctors and everything we tell patients

我們對醫生和病人的一切建議

幾乎都是立基在

is based on the idea that we behave rationally.

「我們的行為是理性的」 這個想法上。

If you give me information, I will process that information in my head,

如果你給我資訊，我就會 在腦中處理這些資訊，

and my behavior will change as a result.

結果，我的行為就會改變。

Do you think Jon Corzine didn't know that seat belts save lives?

你們認為榮科讚不知道 安全帶能救命嗎？

他沒看到留言嗎？

Do you think he, like, just didn't get the memo?

(Laughter)

（笑聲）

Jon Corzine did not have a knowledge deficit,

榮科讚並非知識缺乏，

he had a behavior deficit.

他是行為缺失。

It's not that he didn't know better.

並非他不明白事理。他明白。

He knew better.

It's that he didn't do better.

只是他沒有做到。

Instead, I think the mind is a high-resistance pathway.

反之，我認為

大腦的思路抵抗性是很高的。

Changing someone's mind with information is hard enough.

用資訊改變人的心意已經夠難了。

用資訊改變人的行為

Changing their behavior with information

is harder still.

更是難上加難。

The only way we're going to make substantial improvements

在健康和醫療照護上， 我們能改善的唯一方式，

in health and health care

is to make substantial improvements in the behavior of health and health care.

就是在健康和醫療照護 行為上充分做出改善。

If you hit my patellar tendon with a reflex hammer,

如果你用反射錘敲我的髕韌帶，

my leg is going to jerk forward,

我的腳就會猛然向前彈，

and it's going to jerk forward a lot faster and a lot more predictably

比起我得要自己去想這個動作，

than if I had to think about it myself.

膝反射向前的速度更快， 可預測性也更高。

It's a reflex.

這就是是反射。

We need to look for the equivalent behavioral reflexes

我們得要去找出 類似這樣的行為反射，

and hitch our health care wagon to those.

並把我們的醫療照護行為 導向類似反射行為。

Turns out, though,

不過，結果發現，大部分 用來促發人類動機的傳統方法

that most conventional approaches to human motivation

are based on the idea of education.

都以教育的想法為基礎。

We assume that if people don't behave as they should,

我們會假設如果有人 沒做出應做的行為，

it's because they didn't know any better.

那是因為他們不懂。

「如果大家知道抽菸很危險， 他們就不會抽了。」

"If only people knew that smoking was dangerous, they wouldn't smoke."

Or, we think about economics.

或者，想想經濟。

The assumption there is that we're all constantly calculating

經濟的假設是，我們會不斷地計算

the costs and benefits of every one of our actions

我們每個行為的成本和獲利，

and optimizing that to make the perfectly right, rational decision.

並將之最佳化， 做出完全正確、理性的決策。

If that were true, then all we need to do

若真如此，我們就只需要 為醫生找到完美的付費系統，

is to find the perfect payment system for doctors

or the perfect co-payments and deductibles for patients,

或為病人找到完美的自費額 和保險扣除額，一切就能解決。

and everything would work out.

A better approach lies in behavioral economics.

在行為經濟學中 有個比較好的方法。

Behavioral economists recognize that we are irrational.

行為經濟學家認為 我們是不理性的。

Our decisions are based on emotion,

我們會根據情緒來做決策，

or they're sensitive to framing or to social context.

或決策很容易被 社會環境或規則框架所影響。

We don't always do what's in our own long-term best interests.

我們不見得都會依照 我們長期的利益來行事。

But the key contribution to behavioral economics

但，行為經濟學的關鍵貢獻

is not in recognizing that we are irrational;

並不是認知我們的不理性；

it's recognizing that we are irrational in highly predictable ways.

而是知道我們的不理性

有很高的可預測性。

In fact, it's the predictability of our psychological foibles

事實上，正是我們這個 可預測的心理弱點，

that allows us to design strategies to overcome them.

讓我們能夠設計出克服它們的策略。

Forewarned is forearmed.

預先警告就是預先準備。

In fact, behavioral economists often use

事實上，行為經濟學家通常

precisely the same behavioral reflexes that get us into trouble

就是使用這些讓我們 惹上麻煩的行為反射，

and turn them around to help us,

將之轉換成助力，來協助我們

rather than to hurt us.

而非傷害我們。

We see irrationality play out in something called "present bias,"

我們在所謂的「當下偏見」中 看過不理性的行為，

where the outcomes in front of us are much more motivating

當下偏見就是，比起 遙遠未來中更重要的結果，

than even more important outcomes far in the future.

眼前我們當下的結果 反而讓我們更有行動的動機。

If I'm on a diet -- and I'm always on a diet --

如果我在節食—— 我總是在節食——

(Laughter)

（笑聲）

and someone offers me a luscious-looking piece of chocolate cake,

有人給我一片看起來 很美味的巧克力蛋糕，

I know I should not eat that chocolate cake.

我知道我不該吃那片巧克力蛋糕。

That chocolate cake will land on that part of my body -- permanently --

那片巧克力蛋糕會變成 我身體的那一部分——

永久性的——

where that kind of food naturally settles.

那類食物總會囤積在那個部分。

But the chocolate cake looks so good and delicious,

但那片巧克力蛋糕就在我眼前， 看起來實在好可口，

and it's right in front of me,

節食可以等到明天再做。

and the diet can wait 'til tomorrow.

I used to love the comedian Steven Wright.

我以前很愛喜劇演員史帝芬萊特。 他總有些很禪的妙語。

He would have these Zen-like quips.

My favorite one was this:

我最愛的是這句：

"Hard work pays off in the future,

「努力在未來能得到回報，

but laziness pays off right now."

但懶惰現在就有回報。」

(Laughter)

（笑聲）

And patients also have present bias.

病人也會有這樣的「當下偏見」。

If you have high blood pressure,

如果你有高血壓，

even if you would desperately like to avoid a stroke,

雖然你會非常希望能避免中風，

and you know that taking your antihypertensive medications

你也知道服用抗高血壓藥物

is one of the best ways to reduce that risk,

是減低中風風險的最佳方式之一，

the stroke you avoid is far in the future and taking medications is right now.

但你要避免的中風 是遙遠未來的事，

吃藥則是當前的事。

Almost half of the patients who are prescribed high blood pressure pills

拿到高血壓藥物處方的病人，

幾乎有一半在一年內 就停止服藥了。

stop taking them within a year.

Think of how many lives we could save

想想看，如果我們 能夠解決這一個問題，

if we could solve just that one problem.

就能拯救多少人命。

We also tend to overestimate the value of small probabilities.

我們也傾向會高估 微小可能性的價值。

This actually explains why state lotteries are so popular,

這能夠解釋為什麼 州發行的彩券如此搶手，

even though they return pennies on the dollar.

即使一塊錢得到的報酬只有幾分錢。

Now, some of you may buy lottery tickets --

在座有些人可能會買彩券——

it's fun, there's the chance you might strike it rich ...

彩券很有趣，你確實 有機會可能會致富……

But let's face it:

但，面對現實吧：把你的退休金

this would be a horrible way to invest your retirement savings.

投資在此是很糟的決策。

I once saw a bumper sticker -- I am not making this up -- that said,

我曾經看過一張保險桿貼紙—— 這不是我捏造的——寫著

"State lotteries are a special tax on people who can't do math."

「州彩券是針對不會算數的人

所收取的特別稅。」

(Laughter)

（笑聲）

It's not that we can't do the math,

並非我們不會算數學，

it's that we can't feel the math.

而是我們「感覺不到」數學。

And we also pay much too much attention to regret.

我們也會花太多精力在後悔上。

We all hate the feeling of missing out.

我們都痛恨錯過機會的感覺。

So, actually, there was this recent lottery,

事實上，最近有種 超高額累積獎金的彩券，

a mega-jackpot lottery,

that had a huge payoff, something like over a billion dollars.

報酬可以高達十億美金。

And everyone in my office is pooling money to buy lottery tickets,

我辦公室的每個人 都在集資買彩券，

and I'm not having any of this.

我完全沒有要買。

There I am, like, swaggering around the office,

我在辦公室裡總是嘲笑他們：

"Lotteries are a special tax on people who can't do math."

「彩券是針對不會算數的人 所收取的特別稅。」

（笑聲）

(Laughter)

And then it hits me:

接著，我會想：

uh oh.

呃喔。

What if they win?

萬一他們中了怎麼辦？

(Laughter)

（笑聲）

I'm the only one who shows up at work the next day.

隔天就只有我一個人會來上班了。

（笑聲）

(Laughter)

並不是我不希望我同事中獎。

Now, it's not that I didn't want my colleagues to win.

I just didn't want them to win without me.

我只是不希望他們 在我沒參與時中獎。

Now, it would have been easier if I had just taken my 20-dollar bill

比較簡單的做法就是 我掏出一張二十美元鈔票，

and put it into the office shredder,

放到辦公室的碎紙機裡，

and the results would have been the same.

反正結果都是一樣的。

Even though I knew I shouldn't participate,

即使我知道我不應該參與，

I handed over my $20 bill,

我還是交出了我的二十美元鈔票，

and I never saw it again.

我從此就再也沒見過它了。

(Laughter)

（笑聲）

We've done a bunch of experiments with patients

我們針對病人做過許多實驗，

in which we give them these electronic pill bottles

在實驗中，我們會給病人電子藥瓶，

so we can tell whether they're taking their medication or not.

我們就能知道他們是否有吃藥。

And we reward them with a lottery.

我們給他們的獎勵是彩券。

They get prizes.

他們會得到獎賞。

But they only get prizes

但，他們前一天必須要確實吃藥，

if they had taken their medication the day before.

才能夠得到獎賞。

If not, they get a message that says something like,

如果沒吃藥， 他們會得到像這樣的訊息：

"You would have won a hundred dollars,

「你本來能贏得一百美元， 但你昨天沒吃藥，就得不到了。」

but you didn't take your medicine yesterday, so you don't get it."

Well, it turns out, patients hate that.

結果是，病人很討厭這樣。

They hate the sense of missing out,

他們討厭錯失的感覺，

and because they can anticipate that feeling of regret

因為他們可以預期會有後悔感，

and they'd like to avoid it,

他們會想避免它，

they're much more likely to take their medications.

他們就很有可能會吃藥。

Harnessing that sense of hating regret works.

「利用討厭後悔的感覺」行得通。

And it leads to the more general point,

這就帶出了一個更一般化的重點，

which is: once you recognize how people are irrational,

即，一旦你知道人有多麼不理性，

you're in a much better position to help them.

你就比較能夠去協助他們。

Now, this kind of irrationality works out even in men's restrooms.

這種不理性，

也能用在男洗手間裡。

So, for those of you who don't frequent urinals,

以下送給不常用小便斗的人，

let me break this down for you.

讓我為您說明一下。

(Laughter)

（笑聲）

There is pee all over the floor.

滿地都是尿。

(Laughter)

（笑聲）

And it turns out that you can solve this problem

結果發現，可以解決 這個問題的一種方式

by etching the image of a fly in the back of the urinal.

就是在小便斗後側 印上一隻蒼蠅的圖案。

(Laughter) (Applause)

（笑聲）（掌聲）

And it makes perfect sense.

那非常合理。

(Laughter)

（笑聲）

If I see a fly,

如果我看見一隻蒼蠅，

I'm gonna get that fly.

我一定要射中那隻蒼蠅。

(Laughter)

（笑聲）

That fly is going down.

那隻蒼蠅死定了。

(Laughter)

（笑聲）

Now, this naturally begs the question that if men can aim,

這很自然就帶出了一個問題， 如果男人能夠瞄準，

why were they peeing on the floor in the first place?

那他們到底為什麼會尿到地板上？

In fact, if they were going to pee on the floor,

且，若他們要尿在地板上，

那尿在哪都行， 又何必站在小便斗前面？

why pee in front of the urinal?

You could pee anywhere.

（笑聲）

(Laughter)

And the same thing works in health care.

同樣的方法用在醫療保健也管用。

We had a problem in our hospital

在醫院，有一個問題，

in which the physicians were prescribing brand-name drugs

當可以選擇學名藥時，

醫生們卻一直開品牌藥。

when a generic drug was available.

Each one of the lines on this graph represents a different drug.

在這張圖上的每一條線代表一種藥，

And they're listed according to how often they're prescribed as generic medications.

依據處方開立了 學名藥的頻率列舉出來。

Those are the top are prescribed as generics 100 percent of the time.

位於頂部的是百分之百開學名藥，

Those down at the bottom are prescribed as generics

下面是不到 20% 開立了學名藥。

less than 20 percent of the time.

我們有和臨床醫生開會， 也有各種教育會議，

And we'd have meetings with clinicians and all sorts of education sessions,

and nothing worked --

就是沒輒—— 所有的線幾乎都沒變。

all the lines are pretty much horizontal.

Until, someone installed a little piece of software

直到有人在電子健康記錄中

安裝了一個小軟體，

in the electronic health record

that defaulted the prescriptions to generic medications

把處方預設為學名藥，

instead of the brand-name drugs.

而不是品牌藥。

Now, it doesn't take a statistician

不用統計學家也看得出來， 問題一夜之間就解決了，

to see that this problem was solved overnight,

and it has stayed solved ever since.

此後也一直維持已解決的狀態。

In fact, in the two and a half years since this program started,

事實上，從這個方案 開始之後兩年半，

our hospital has saved 32 million dollars.

醫院省下了三千兩百萬美元。

Let me say that again: 32 million dollars.

讓我再說一次：三千兩百萬美元。

And all we did was make it easier

我們做的只是讓醫生更容易

for the doctors to do what they fundamentally wanted to do all along.

去做他們基本上一直想要做的事。

It also works to play into people's notions of loss.

利用人性怕錯失的心理， 用這方法也很有效。

We did this with a contest to help people walk more.

我們做了一個 協助大家多走路的競賽。

We wanted everyone to walk at least 7,000 steps,

我們希望每個人能走至少七千步，

and we measured their step count

我們用他們手機上的 加速感測器來計步。

with the accelerometer on their cell phone.

Group A, the control group, just got told whether they had walked

A 組是控制組，

只被告知他們走了七千步沒有。

7,000 steps or not.

Group B got a financial incentive.

B 組則可以得到金錢的獎勵。

We gave them $1.40 for every day they walked 7,000 steps.

他們若一天能走七千步， 那天就能拿到 $1.40 美元。

Group C got the same financial incentive,

C 組也有同樣的金錢獎勵，

but it was framed as a loss rather than a gain:

但把它描述成損失而不是獲得：

$1.40 a day is 42 dollars a month,

一天 $1.40，一個月就有 $42，

so we gave these participants 42 dollars at the beginning of each month

所以我們每個月開始時 會給這些受試者 $42 ，

in a virtual account that they could see,

放在他們能看見的虛擬帳戶中，

and we took away $1.40 for every day they didn't walk 7,000 steps.

一天沒有走到七千步， 那天就扣除 $1.40。

Now, an economist would say that those two financial incentives

經濟學家會說這兩種金錢獎勵

are the same.

是一樣的。

For every day you walk 7,000 steps, you're $1.40 richer.

每天只要走到七千步， 就可以多出 $1.40。

But a behavioral economist would say that they're different,

但行為經濟學家會說， 這兩種方式不同，

because we're much more motivated to avoid a $1.40 loss

因為，比起達成每天賺 $1.40，

than we are motivated to achieve a $1.40 gain.

我們會更有動機 去避免每天損失 $1.40。

And that's exactly what happened.

結果的確如此。

Those in the group that received $1.40 for every day they walked 7,000 steps

每天只要走七千步 就能得到 $1.40 的那組

were no more likely to meet their goal than the control group.

並沒有比控制組 更有可能達到目標。

The financial incentive didn't work.

金錢獎勵沒有用。

But those who had a loss-framed incentive

但用損失方式描述獎勵的那組，

met their goal 50 percent more of the time.

達成目標的機會高出 50%。

It doesn't make economic sense, but it makes psychological sense,

在經濟上是不合理的， 但心理學上很合理，

because losses loom larger than gains.

因為損失的嚴重性比獲得更大。

And now we're using loss-framed incentives to help patients walk more,

現在我們都把獎勵用損失的方式 來描述，協助病人多走路、

lose weight

減重，並按時吃藥。

and take their medications.

Money can be a motivator.

金錢可以引發動機。我們都知道。

We all know that.

But it's far more influential when it's paired with psychology.

但把金錢和心理結合， 影響力會更大許多。

And money, of course, has its own disadvantages.

當然，金錢也有它自身的缺點。

My favorite example of this involves a daycare program.

我最喜歡的例子 和一個托兒方案有關。

The greatest sin you can commit in daycare is picking up your kids late.

在托兒方面， 你所能犯下最嚴重的罪過

就是該接孩子時接晚了。

No one is happy.

大家都不開心。

Your kids are crying because you don't love them.

你的孩子在哭，因為你不愛他們。

(Laughter)

（笑聲）

The teachers are unhappy because they leave work late.

老師不開心， 因為他們因此要晚下班。

And you feel terribly guilty.

你則有很強的罪惡感。

This daycare program in Israel decided they wanted to stop this problem,

在以色列的這個托兒方案 想要解決這個問題，

and they did something that many daycare programs in the US do,

他們做了美國許多 托兒方案都會做的事，

which is they installed a fine for late pickups.

設定了接孩子遲到的罰金。

And the fine they chose was 10 shekels,

他們訂的罰金是十錫克爾，

which is about three bucks.

大約等於三美元。

And guess what happened?

猜猜結果如何？

Late pickups increased.

接孩子遲到的情況變多了。

And if you think about it, it makes perfect sense.

仔細想想，這非常合理。

What a deal!

真划算！只要十鍻克爾——

For 10 shekels --

(Laughter)

（笑聲）

you can keep my kids all night!

就可以把孩子丟在那裡整晚！

(Laughter)

（笑聲）

They took a perfectly strong intrinsic motivation not to be late,

他們把父母要求自己 不遲到的強力內在動機拿來用，

and they cheapened it.

還把它變廉價了。

What's worse, when they realized their mistake

更糟糕的是， 當他們發現這個錯誤，

and they took away the financial incentive,

他們把金錢罰金取消，

the late pickups still stayed at the high level.

但接小孩遲到的狀況 仍然非常頻繁。

They had already poisoned the social contract.

他們已經毒害了這個社會契約。

Health care is full of strong intrinsic motivations.

醫療照護當中有很多 強力的內在動機。

We have doctors and patients who already want to do the right thing.

有醫生和病人心裡 已經想要去做對的事。

Financial incentives can help,

金錢獎勵能幫得上忙，

but we shouldn't expect money in health care

但我們不能期望在醫療照護中

to do all of the heavy lifting.

用金錢解決所有的難題。

Instead, perhaps the most powerful influencers of health behavior

反之，對健康行為 最有影響力的因子

are our social interactions.

也許是我們的社交互動。

Social engagement works in health care,

在醫療照護中， 社會參與是有用的，

and it works in two directions.

在兩個面向上都有用。

First, we fundamentally care what others think of us.

第一，

基本上，我們在乎 別人對我們的看法。

And so one of the most powerful ways to change our behavior

所以，要改變我們行為， 最強大的方式之一，

is to make our activities witnessable to others.

就是讓他人能夠看見我們的活動。

We behave differently when we're being observed

我們在被別人觀察時 和沒被觀察時，行為會不同。

than when we're not.

I've been to some restaurants that don't have sinks in the bathrooms.

我去過一些餐廳， 它們廁所裡沒有洗手台。

Instead, when you step out, the sink is outside

你要走出去，洗手台在外面 餐廳的主要區域裡，

in the main part of the restaurant,

where everyone can see whether you wash your hands or not.

大家都能看見你有沒有洗手。

我不敢確定，但我相信

Now, I don't know for sure,

but I am convinced that handwashing is much greater

在那些情況下大家比較會去洗手。

in those particular settings.

We are always on our best behavior when we're being observed.

當我們被觀察時，我們總會 做出我們最好的行為。

In fact, there was this amazing study

有項很驚人的研究，

that was done in an intensive care unit in a Florida hospital.

在佛羅里達一間醫院的 加護病房中進行。

The handwashing rates were very low, which is dangerous, of course,

洗手的比率非常低， 當然，這樣是很危險的，

because it can spread infection.

因為可能會散播感染。

And so some researchers pasted a picture of someone's eyes over the sink.

所以，研究者在洗手槽上面貼了 一張照片，某個人的眼睛的照片。

It wasn't a real person, it was just a photograph.

那只是一張照片，不是真人。

In fact, it wasn't even their whole face, it was just their eyes looking at you.

事實上，照片中甚至沒有整張臉， 只有一對眼睛看著你。

（笑聲）

(Laughter)

洗手的比率變成至少兩倍。

Handwashing rates more than doubled.

It seems we care so much what other people think of us

似乎，我們相當在乎 別人怎麼看待我們，

that our behavior improves

即使我們只是想像有人在觀察我們

even if we merely imagine that we're being observed.

就足以讓我們的行為有所改善。

And not only do we care what others think of us,

我們不僅在乎別人對我們的看法，

we fundamentally model our behaviors on what we see other people do.

我們基本上還會去 模仿別人的行為。

And it all comes back to seat belts.

再回到安全帶。

When I was a kid, I used to love the "Batman" TV series with Adam West.

小時候，

我很愛亞當韋斯特 主演的《蝙蝠俠》影集。

Everything that Batman and Robin did was so cool,

蝙蝠俠和羅賓所做的一切都好酷，

and, of course, the Batmobile was the coolest thing of all.

當然，蝙蝠車是當中最酷的。

Now, that show aired from 1966 to 1968,

這個影集從 1966 年演到 1968 年，

and at that time, seat belts were optional accessories in cars.

那時，安全帶還是 汽車的選配配備。

But the producers of that show did something really important.

但那個節目的製作人 做了一件非常重要的事。

When Batman and Robin got in the Batmobile,

當蝙蝠俠和羅賓坐進蝙蝠車時，

the camera would focus on their laps,

鏡頭會帶到他們的大腿，

and you would see Batman and Robin put on their seat belts.

你可以看到蝙蝠俠和羅賓 都有繫上安全帶。

Now, if Batman and Robin put on their seat belts,

若蝙蝠俠和羅賓都有繫安全帶，

you can bet that I was going to wear my seat belt, too.

就可以肯定我一定 也會繫上安全帶。

I bet that show saved thousands of lives.

我敢說那個節目 拯救了數千條人命。

And again, it works in health care, too.

同樣的，這招 在醫療照護也行得通。

Doctors use antibiotics more appropriately when they see how other doctors use them.

當醫生看到其他醫生 怎麼用抗生素時，

他們會更妥當地使用抗生素。

So many activities in health care are hidden, they're unwitnessed,

在醫療照護中，有許多活動

都是隱藏的、別人看不見的，

but doctors are social animals,

但醫生是社交動物，

and they perform better when they see what other doctors do.

當他們看到其他醫生的行為時，

他們也會做得更好。

So social influence works in health care.

所以，在醫療照護中， 社會影響是有用的。

So does tying it to notions of regret or to loss aversion.

後悔念頭或討厭損失也都行得通。

We would never think of using these tools if we thought that everyone was rational

如果我們認為每個人總是理性的，

就永遠不會去用這些工具了。

all the time.

Now, just to be clear: I am not condemning rationality.

讓我說清楚：我並非譴責理性。

I mean, that really would be irrational.

那樣做就太不理性了。

But we all know that it's the nonrational parts of our minds

但，我們都知道，

正是大腦中不理性的部分

where we get courage, creativity, inspiration

給了我們勇氣、創意、靈感，

and everything else that sparks passion.

以及協助點燃熱情的一切。

And we know something else, too.

我們還知道一件事。

We know that we can be much more effective at improving health behavior

我們知道我們能夠 更有效地改善健康行為，

if we work with the irrational parts of our nature

只要我們能夠利用 我們天性中不理性的部分，

instead of ignoring them or fighting against them.

而不是忽略或對抗這些部分。

When it comes to health care,

談到醫療照護時，

understanding our irrationality is just another tool in our toolbox.

了解我們的不理性，

是我們的工具盒中的一樣工具。

And harnessing that irrationality --

利用那不理性——

that may be the most rational move of all.

可能是我們所能採取的所有 行動中，最理性的一個。

Thank you.

謝謝。

(Applause)

（掌聲）