Analysis of Paralysis

Senior doctors at Ontario College of Family Physicians were examining the medical record of a 67 yr old patient with chronic hip pain from arthritis. Drugs had been ineffective in curing his pain. The doctors had to make a decision: to refer hip-replacement surgery or try an untested medicine that had just been suggested by the pharmacy.

‘Hip surgery is painful and has a long recovery’ said a doctor ‘The thigh is sliced open. Bone is wrenched out from the socket and the arthritic end is sawed off. Implant is then replaced. Untested medicine is worth it even though the patient has not responded to drugs earlier. I will avoid surgery’

Meanwhile, another set of surgeons were looking at the same case facts but were given an additional option. They were told TWO untested medicines were available in the pharmacy.

The majority response of this group was stunning ‘Will opt for surgery. Unsure of these medicines’

53% of the doctors had opted for the non-surgical option when they had just the choice of 1 untested medication. But only 28% opted for either when 2 medicine options were given. 72% chose to go ahead with painful hip replacement surgery.

The researchers, Dr Donald Redelmeier and psychologist Eldar Shafir induced this dilemma in a classic paper they published in the 1990’s on Decision Paralysis:

More options, even good ones, can freeze us, leading us to stick with the default plan. Which in this case was slicing open someone’s hip. It was not rational. But human behaviour.

The need for Leaders to keep things simple is more fundamental: Simplicity allows people to act.


One of the best books on How to Change things, when change is hard is Switch by Chip & Dan Heath brothers. They present this case in the Chapter 3. It is a must read, if you haven’t yet.

The seminal paper that has been published by the two researhers can be accessed here again.

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