David Krueger MD

Every time we experience something and don’t encounter a negative outcome, we get the wrong impression that it’s safer than we thought it was.
Dan Ariely

Many years ago, when I was coaching a weekend basketball team, one of the guys I’ll call Pete had particular difficulty regulating his behavior in games.  After three technical fouls in the first two games, despite team discussions, a technical was called on Pete in the third game.  I called a time out and motioned him over to talk privately.  “Pete, that is the next-to-last technical foul you will ever get as a player on my team.”  He looked at me with an astonished expression to know I was serious.  Then I said, “I believe in you and want you to still be my starting center if you decide.”  He knew simply and specifically what to expect as a consequence of each choice.  For the remainder of the season he never got that last technical foul, and came to be a leader and second highest scorer on the team.

For our current coronavirus situation:  What do you expect?  There is no mystery.  The consequences are very clear.  If you disregard social distancing, masking, and precautionary methods, the chances of contracting the coronavirus infection increase exponentially.  See my earlier blog, Coronavirus Omission Bias

Perhaps a review of the mind and brain sciences applied to choice architecture can be informative. 

  • First order consequences are the immediate, obvious, and intended results of doing something.  The pleasure of eating cheesecake with strawberry topping; going to the beach or bar with friends after significant isolation. 
  • Second order consequences track the outcome of first order decisions. Since our brain patterns favor first order decisions of immediate pain avoidance or pleasure seeking, a second order consequence requires sustaining focus and work for immediate pain avoidance or reward.  To stay the course to pursue a greater gain. 
  • Third order consequences are the longer-term result of a decision.  The structure of a system with stepwise goals reinforces sustained effort to pursue a greater benefit.

The goal does not differentiate the winner from the loser.  The system does.  To focus only on the immediate, first order consequence can lead to mistakes in decision-making by ignoring the big picture. The first order decision is challenging because it is based on our own biases, on automatic and intuitive choice in our unconscious operating system of already established algorithms of attachment, behavior, and emotion.  The first order decision is obvious, easy, immediately reinforcing, yet does not consider subsequent implications.

Second and third order consequences are more challenging, because they may involve an immediate restraint of gratification to consider natural consequences less immediately rewarding.  If you do not prepare, your performance likely suffers.  If you do not mask, wash, and social distance, the natural consequence becomes greater vulnerability to individual and group infection. 

The best judgements and choices consider all three levels in decision-making, a strategic system to achieve and sustain success.

And keep it simple.  A track coach in Texas kept things clear and brief.  Before the race began, he told his runner, “Stay to your left and get back here as soon as you can.”

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