[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today I have the pleasure of speaking with Dr. Barry Schwartz. Dr. Barry Schwartz is an Emeritus Professor of Psychology at Swarthmore College and a Visiting Professor at the Haas School of Business at Berkeley. He has spent 50 years thinking and writing about the interaction between economics, psychology, and morality. He has written several books that address aspects of this interaction, including The Battle for Human Nature, The Costs of Living, The Paradox of Choice, Practical Wisdom, and most recently Why We Work. Dr. Schwartz has written for sources as diverse as the New York Times, The New York Times Magazine, the Chronicle of Higher Education, Slate, Scientific American, The New Republic, and the Harvard Business Review, as well as The Guardian. He has spoken four times at the TED Conference and his TED Talks have been viewed by more than 25 million people. Welcome to Barry.
[00:00:54] Barry Schwartz: Thank you very much. It's a pleasure to be with you, Christine.
[00:00:58] Christine Ko: Could you first share a personal anecdote?
[00:01:01] Barry Schwartz: Sure. Years ago I used to wear jeans all the time, every day. And I hated buying new jeans because you had to break them in, and they were uncomfortable. So I would wear them until my wife refused to be seen in public with me, and then I would go and buy new ones at The Gap. And so I went in and I told them my size and I said, I'd like a pair of jeans. The clerk said, do you want slim fit, easy fit, relaxed fit? You want button fly zipper, fly acid wash, stone wash, boot cut tapered? And I said, wait, I want the kind that used to be the only kind. And of course they didn't make that kind anymore. So I ended up trying on all these different styles and cuts and of jeans, and I walked out with the best fitting jeans I had ever owned. In other words, I did better thanks to all the options, but I felt worse. The reason I wrote the book is I was trying to figure out why it felt worse. When jeans only came in one or two styles, my expectations about how well they would fit were pretty low. I don't exactly have a model's body. But when they came in all these styles, all of a sudden I figured, somewhere out there, there's a pair of jeans that's perfect. So what I got was good, but it wasn't perfect. So compared to what I was expecting, I felt like it had failed. Not to mention that instead of taking five minutes to buy jeans, it took 45 minutes. So what I discovered there is that when freedom of choice is good and people deeply value it, especially in the US and other western democratic societies, there can be too much of a good thing. And when people have too many options, whether it's about jeans or more significant things, they end up paralyzed. Then when they make their choices, they end up dissatisfied. And so the challenge for us as individuals and and for us as a society is to figure out what, how much choice is the right amount of choice so that people can take advantage of freedom and flexibility without being tortured by it. So that's a real life anecdote.
[00:03:10] Christine Ko: That's actually how I first got introduced to your work. I read that book, The Paradox of Choice. After having written that book and examined this and thought about it, do you have a sort of simple answer on what the right number of choices is to fix this paradox?
[00:03:28] Barry Schwartz: There is no simple answer, unfortunately. Individuals differ. And domains differ. So if you are really interested in cars, you might want 50 choices when time comes to buy a new car. If you're not interested, you'll be happy with three or four. Some decisions are more complicated than others, and you may want more options in some cases than in others. If you're in the business world, you ask the question, how many styles of jeans should we produce? You do the research to figure out how much variety enhances the experience and how much variety ends up with people leaving your store empty handed. And there'll be an answer. But the answer for jeans and the answer for cereal and the answer for health insurance won't necessarily be the same answer. So I think you just have to do the research.
[00:04:19] As individuals, I think there's a lot we can do even if the world is not cooperating. I should say this book came out originally almost 20 years ago, and internet shopping was a thing, but it wasn't the thing it has become. So one piece of advice I give people is, don't ever click the show all button. Look at them one screen at a time. If you find something that meets your needs, stop looking. I think mostly people don't take that advice, but they would be happier if they did.
[00:04:53] The second thing I advise people, and this is I think the most important thing. My colleagues and I have done a lot of research on this. You can approach a decision and ask, what's the best possible choice? And people who do that, we have come to call maximizers. They want the best jeans, the best restaurant, the best vacation, the best job, the best college. Or you can approach a decision and ask what's a good enough choice. And your standards in some domains may be pretty low. You may not care much about what cereal you have for breakfast and in other domains they may be quite high, but you don't need the best. You look at the options until you find something that meets your standards and then you stop looking. And we call people like this satisficers. They are looking for an option that is good enough. And what we find, people differ. Some people are more likely to be maximizers and some more likely to be satisficers, and maximizers have a much harder time getting through life, a harder time making decisions, and they are less satisfied with the decisions when they make them. And even if they end up making better decisions, it doesn't really help because you feel like you made a worse decision. Like with my jeans, what good did it do me that I had good fitting jeans? I walked around thinking my shopping trip had been a failure. Everybody is a satisficer about some things. So the advice I give, the challenge, which I think is worth taking up, is to be a satisficer about more and a maximizer about less. Then, no matter what the world throws at you, it becomes much more manageable to make decisions.
[00:06:34] Christine Ko: That kind of segues into another question that I wanted to ask you, which is how to make a good decision? Maybe with what you just said, it's just how to make a good enough decision. [Yes.] So to paraphrase, it almost sounds like you just answered that, just to say, don't be a maximizer if at all possible, and be a satisficer.
[00:06:55] Barry Schwartz: Yeah, but there's a little more than that. Another piece of advice I sometimes give people is this, don't just do something, sit there, which is of course the reverse of what the advice you're usually given. What I mean by that is it's really hard to make a good decision unless you know why you are making the decision. What matters to you when you're choosing a job? What's most important when you're trying to decide where to go to medical school or where to go to college? What's most important? Sit there and think about you and what matters to you. And then having figured it out, you can go out into the world and look for a place that will satisfy your needs and your desires. Now, I don't wanna suggest that this is foolproof. We'll make mistakes. We think we're interested in biology. We go to a university as a great bio department, and we discover that we're actually interested in music. And maybe if we'd known that as high school seniors, we would've applied to different schools. So there's no guarantee you're always gonna get it right. But I think what a lot of us do is we think a little bit about why we're deciding. The more we can think about what we care about in advance, the easier it is to pull the trigger when we actually are trying to decide.
[00:08:10] Christine Ko: Makes sense. Part of the reason I do this podcast is I'm always trying to bring it back to healthcare and doctors and patients and sort of decision making in healthcare by doctors and patients. Since healthcare literacy is on the relatively low side, in a way, doctors are making these decisions for patients a lot of times, without meaning to maybe, the way you present information, framing, a lot of cognitive bias, all of that. Listening to what you just said, I am thinking that is a reason why you really need a good relationship between a doctor and a patient so that the doctor can sit with the patient and help frame and guide the conversation in the way that is most helpful for that particular patient.
[00:08:55] Barry Schwartz: That's exactly right. But notice the way you ended what you just said. The most helpful for that particular patient? Yes. Now, what does that mean? That means that doctors have to know their patients. And the way medical care is provided these days in the United States, doctors don't know their patients. They approach things very formulaically. They have short amounts of time for office visits, and almost that entire time is spent with the doctor looking at the computer screen. And so the idea that you can make a decision on behalf of this particular person who is sitting in front of you is just a fantasy because you don't know much about this particular person. You can do little things at the margins if you're a practicing physician to steal an extra few minutes in each office visit and try to get to know your patient. You can make small changes, but the structure of medical practice virtually guarantees that you can't make big changes. And I fear that it's big changes that are needed.
[00:09:57] Christine Ko: I agree. I think big changes are needed. Healthcare's in trouble.
[00:10:00] Barry Schwartz: 90% of people in surveys indicate that they are either unsatisfied or actively dissatisfied with the work that they do. Doctors are leaving the profession because the profession is not providing what they thought it would. It is not nourishing their souls, and they thought it would, or at least that was part of why they did it. Yes, there are intellectual puzzles that are challenging and doctors love, I assume to be challenged and to solve problems in that way, but there's also this interpersonal thing and that they feel deprived of and they think they'd be better doctors if they were able to spend more time getting to know their patients.
[00:10:39] So to the extent that healthcare requires individualized treatment, I think you're right that you have to change the way healthcare is provided so that doctors can make intelligent decisions about individuals instead of foolish ones. You're right that our healthcare literacy is terrible. Maybe it's getting a little bit better because of the internet, although people go get steered to the wrong sites and it could actually make them even more confused. But it is certainly the case that there is a huge asymmetry between the doctor and the patient in terms of information.
[00:11:13] There's a kind of slogan these days in medicine, joint decision making, where the patient ultimately makes the decision, but the doctors guides, steers, nudges in various directions. That seems to me to be a reasonable approach, but it only works when doctors know their patients. And that has become less and less common. So what this takes, unlike the sort of decision making about jeans, it takes a kind of wisdom that comes only from experience. Some patients, you can be just the facts, and you can be brutal and unambiguous. Other patients, if you behave in that way, you'll basically destroy them. In fact, as soon as the word cancer comes out of your mouth, they don't hear anything else. Now you don't know which patient you're dealing with unless you know the patient, and you have to, I think, tailor the conversation to the sort of emotional resilience, educational competence of the person you're talking to. And I don't know how much training you get in medical school for about that, I'm guessing close to none.
[00:12:23] There's a wonderful article, by the way, that appeared in The New Yorker years ago by a very distinguished doctor named Jerome Groopman. He's an oncologist at Harvard and the title of the article is Dying Words. It's about how you give patients bad news. He describes how good he was at this when he first started practicing, and he was an unmitigated disaster. And the reason is he had never seen a single conversation like this when he was being trained: the doctor had the conversation with the patient behind closed doors, so he started out basically just completely unequipped. Made one terrible mistake after another. Sometimes too blunt, sometimes not blunt enough, and back and forth.
[00:13:11] But unlike a lot of people he was open enough to being educated by his failures. And after, years and years of experience, he really got exquisitely good at it. And his point in this article is that this is not just about giving bad news to patients. This is about how we as doctors need to interact with patients in general. It's a skill that you learn by doing and by watching.
[00:13:35] Christine Ko: You mentioned wisdom before, and you have a whole book called Practical Wisdom. Can you talk a little bit about practical wisdom?
[00:13:43] Barry Schwartz: Sure. There's a kind of wisdom that enables us to make very concrete, practical decisions on a daily basis, like how to talk to a patient. Whether to be honest in a conversation with a friend. We all think that you always wanna be honest, but sometimes when you're honest, all you are is hurtful and you need to figure out how to balance honesty with kindness.
[00:14:06] So it takes judgment to know how to approach a patient, a friend, a romantic partner, a student in a class. With some students you should be tough because they're lazy. With other students, you should be encouraging because they're struggling. The right answer is going to depend on the particular person and the particular situation. So there's no general rule. The way we described this is a kind of moral jazz. You improvise around the guidelines to find what fits for the particular person you're talking with in the particular context in which the conversation is happening.
[00:14:43] And it comes from experience, by doing it badly, making mistakes, and gradually getting better. The complicated social world that people live in demands this kind of judgment case by case, individual judgment, rather than any sort of abstract approach, say patient autonomy, that gets applied like a cookie cutter to every case that we face. We talk about it in the context of being a lawyer, being a teacher, being a doctor, being a parent. My co-author, Kenneth Sharp and I, we regard it as the key virtue for people to have when they are living their lives among other people and having to make decisions on behalf of other people. So that's what Practical Wisdom is. It's a good book. There's a Ted Talk on it too, which takes a lot less time than reading the book. I think it's really what's missing for medicine and from training in medicine.
[00:15:41] Christine Ko: I think it comes back to what you were saying earlier that just as a parent or a lawyer or a doctor, it's like for that each particular individual relationship...
[00:15:50] Barry Schwartz: No parent who has more than one child thinks that the way you raise your children should be by formula, that you treat every kid the same. What is the same? If we're being good parents, is our desire to provide what our children need. But what that's going to mean is that we treat each kid differently because our kids need different things and yeah, eventually your children teach you what they need.
[00:16:17] Child number two teaches you, I am not child number one. I need different things. You can't treat me the same way. And if your eyes are open and your ears are open, you eventually adopt a different style with child number two. So we're used to that in the personal domain. We're not used to it when it comes to dealing with patients and clients and students. But the same thing applies there. And the challenge, of course, is that we don't know patients and clients and students nearly as well as we know our kids. So it's harder to get it right, but that doesn't mean you shouldn't try.
[00:16:51] Christine Ko: I haven't had a chance to read your more recent book, Why We Work. Do you mind talking a little bit about that?
[00:16:57] Barry Schwartz: So of course we work for, to make a living. But it isn't the most significant part of why we work. If we're lucky, we work because the activities that occupy us make our lives more meaningful. We're doing something that makes a difference to some body somewhere. The point of the book was just to remind people of what they probably already know, which is that work can be and should be more than a paycheck.
[00:17:27] Christine Ko: Do you have any final thoughts?
[00:17:29] Barry Schwartz: You've really asked wonderful questions and the result is that I don't have any final thoughts. We have covered the waterfront. Think about how the kinds of things we talked about might apply because nothing that we talked about is unique to medicine.
[00:17:45] Christine Ko: Yes. Thank you very much for spending time.
[00:17:48] Barry Schwartz: My pleasure. My pleasure.
