Is it the white coat?  That’s what I wondered in medical school when I would find patients asking me for advice on topics they simply had to know more about than me.  Mothers would ask me how to get their newborn babies to sleep through the night, asking me even though the one time I babysat I fell asleep on the family’s couch only to be woken up by their 4-year-old, asking me whether it was okay if she went to bed now.

Elderly men and women would ask me how to cope with fear of dying, asking me even though at the ripe old age of twenty-four I had not ever experienced that feeling.

Middle aged women would ask me whether I thought they should get mastectomy or lumpectomy to treat their newly diagnosed breast cancers, asking me even though I knew the decision was not a pure medical judgment but instead depended on their values, and whether they felt that preserving part of their breast was worth six weeks of radiation treatment.

I thought it was simply the white coat and all the knowledge it symbolized.  But having just read Francesca Gino’s wonderful new book, Sidetracked: Why Our Decisions Get Derailed, and How We Can Stick to the Plan, I have a much richer understanding of when, and why, people choose to rely on advice.

Gino is a researcher at the Harvard Business School, who has conducted a ridiculous number of creative and revealing studies.  A few of her studies cleverly demonstrate that people often ignore good advice.  For example, she reports on data from a game show back in her native Italy, in which contestants are able to ask the audience for advice.  Analysis of behavior over hundreds of shows revealed that contestants lost millions of Euros by ignoring the audience’s advice.  Gino’s own research showed that people frequently ignore advice even when it comes from experts.  For example, she gave college students 20 minutes to grapple with a challenging business case, then told them that a group of MBA students (all of whom had consulting experience) had spent 40 minutes working on the same case.  She gave them an opportunity to take advantage of the MBA students’ analyses.  The majority of undergraduate students completely ignored this input, confident that their own ideas would be superior.

So much for my simple white coat idea.  Gino’s research proves that people are often willing to dismiss expert advice.  I recognize, of course, that the gap in knowledge between physicians and patients is larger than that between, say, UNC undergrads and MBA students.  And I expect smart undergrads feel more confident about solving common sense business cases than they would feel deciding what chemotherapy is best for acute myelogenous leukemia.  But Gino’s work reveals that people can ignore expert advice even when that advice is in their best interests.

So why, then, do people lean so heavily on physician advice?  Gino’s research points toward several good answers.

First, they rely on such advice because the advice is so expensive.  Give people advice for free, and they will have a tendency to ignore it.  Give the same advice but charge them for it, and people pay attention.  Gino found this out by determining the price of advice through a coin flip.  Despite the arbitrariness of this pricing scheme, the mere act of paying for advice made people more likely to take the advice.

Second, people rely on doctorly advice because they feel powerless.  Gino describes one of her studies in which she asked a group of people to write about situations in which other people had power over them.  In the same study, she asked another group of people to write stories about situations where they were the ones in charge.  She subsequently asked both groups of people to estimate the combined weight of a group of people pictured in a photograph.  She also gave them an estimate someone else had made.  People who had written about being powerless were more likely to adjust their estimate based on the other person’s guess.  Being powerless makes people more likely to rely on others.

Third, people seek advice when their situation feels complicated and confusing.  Gino cleverly studied this phenomenon by making a subtle change to the weight guessing game I described above.  In this version of the study, half of the people received the normal photograph, and the other half received a blurry copy of the photograph.  All of them received estimates from other people who had seen the same photograph that they had seen.  People looking at the blurry photograph were understandably less confident about the weight of the people pictured therein, given that it was harder to discern just how many people were in the picture.  Consequently, they were more likely to be influenced by the guesses that other people made.  Makes sense until you realize that the other people had seen the same blurry picture that they had.  Why is that advice any better than your own guess?  And if that advice is good, then why won’t you take it when you see a clearer photograph?

Now let us reflect on what happens every day in doctors’ offices.  A patient sits on a table, perhaps only half clothed, looking up at a white-coated, highly paid physician who speaks inscrutable Latin sounding words, laying out a complex and confusing decision.  Based on Gino’s research, this sounds to me like a recipe guaranteed to leave patients to rely on their doctors for advice.

Is that a problem?  Often not.  We physicians, after all, know a great deal more about medicine than our patients.  Our advice is often based on years of experience woven together with our expert interpretation of the medical literature.

But it is a problem to rely on doctors’ advice when your doctor’s recommendation involves judgments that might conflict with your own values as a patient.  When your oncologist urges you to undergo a course of “salvage chemotherapy,” is that because she cares less about quality of life than you do when pursuing a small chance of prolonging your life?

My advice on taking advice?  Figure out the difference between medical facts and value judgments.  Make sure, at a minimum, that your physician understands your values before you ask her for advice.

**Previously posted on Forbes**

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