Making health habitual

I was delighted to find that Gardner's useful article on promoting healthy habits1 referred to Kahneman's Nobel prize-winning findings about how people think.

Kahneman's central point is that we use two different kinds of thinking. ‘System 1’ thinking works fast, using intuitive mental short-cuts. ‘System 2’ thinking is slower, rational, and deliberative. In his very readable book2 Kahneman demonstrates that System 1 is what people use most of the time, even highly-educated, numerate people like the students who volunteered for his experiments: they were unaware of jumping to conclusions, and shocked when later shown the errors this had led them to make. When given increasingly complex tasks that forced them to switch into using System 2 thinking, they reported that this felt like hard work, and Kahneman observed highly-consistent physiological changes associated with this feeling.

Explaining things to people and helping them make choices is central to our job as GPs. It is high time we stopped acting as if people were likely to respond by engaging in System 2 thinking, or to be comfortable when given tasks that require it. For example, the whole enterprise of communicating risk and facilitating shared decision-making is aimed at an imaginary patient who weighs up the facts and her doctor’s advice alongside her individual preferences in order to compute a rational choice. We should acknowledge that this patient is a very rare bird, and begin working out how best to interact with System 1 thinkers, as Gardner et al suggest.

While we are about it, our own learning and teaching would be improved by recognising how seldom we use System 2 thinking ourselves, especially within 10-minute consultations. Healthy (consultation) habits are what keep us safe most of the time, but the drawbacks of intuitive short-cuts explain many of our mistakes, mistakes that often seem surprising when examined retrospectively using System 2 thinking. We should all read Kahneman!

• © British Journal of General Practice 2013