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Right arrow Problems in Clinical Judgement Series
CMAJ • June 25, 2002; 166 (13)
© 2002 Canadian Medical Association or its licensors

Review
Synthèse

Problems for clinical judgement: 5. Principles of influence in medical practice

Donald A. Redelmeier* and Robert B. Cialdini{dagger}

From *the Department of Medicine, University of Toronto, and the Division of Clinical Epidemiology and Health Care Research, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.; and {dagger}the Department of Psychology, Arizona State University, Tempe, Ariz.

Correspondence to: Dr. Donald A. Redelmeier, Rm. G-151, Sunnybrook & Women's Health Sciences Centre, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; dar@ices.on.ca

Abstract

THE BASIC SCIENCE OF PSYCHOLOGY HAS IDENTIFIED specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences the attractiveness of a request. Authorities have power beyond their expertise. Opportunities appear more valuable when they appear less available. These 7 responses were discovered decades ago in psychology research and seem intuitively understood in the business world, but they are rarely discussed in medical texts. An awareness of these principles can provide a framework for physicians to help patients change their behaviour and to understand how others in society sometime alter patients' choices.




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