CAUTION: Inattention Is Hazardous to Health

Sep 3, 2013

Inattention can be dangerous for drivers and hazardous to healthcare, too. And systems designed to account for inattention can improve outcomes.

In a relatively short span, the ability to multitask has come to be seen as a matter-of-fact necessity of contemporary life.

The trouble is, we haven’t evolved as fast as the technology and economic factors that thrust multitasking upon us. Our conscious brains still process only 50 bits per second, but there are constantly competing demands for that attention.

Thus, the byproduct of multitasking is inattention, and that can be dangerous:

  • In July, a passenger train in Spain derailed while traveling 111 miles per hour on a curve for which the speed limit was 50 mph. Seventy-nine passengers died. The driver had received three automated warnings to slow down and later was at a loss to explain how he could have missed them. At the time, he was having a cellphone conversation with the train’s ticket inspector.
  • A similar accident occurred in southern California in 2008, in which a commuter train's driver missed a stop sign and collided head on with a freight train; the driver had sent a text message 30 seconds before the collision.
  • Two separate studies – one from Australia and the other from Canada – found that using cell phones while driving quadrupled the chance of an accident, and the accident rate was similarly elevated with the hands-free feature.
  • Similarly, a randomized trial in a simulator showed that cell phone use impaired driving to a degree comparable with being legally intoxicated.

The problem with the operating systems for trains, planes and automobiles – as indeed with much of our daily life – is that they assume that the task at hand will receive our full attention.

With mobile phones, the impediment is not just the mechanics of holding the phone or dialing; studies find similar rates of distraction with or without a hands-free feature. Our ability to recognize potential problems and respond accordingly is significantly reduced as we focus our scarce 50 bits on the conversation taking place.

The assumption of full attention has been integral to our healthcare system, too. Inattention is equally dangerous there, leading to poor outcomes, gaps in care and wasteful spending.

Despite the historic lack of success in this approach, the healthcare sector continues to focus on efforts aimed at increasing patient engagement.

At Express Scripts, we take inattention into account. We pioneered the application of advanced behavioral science to help patients make better decisions about medications, pharmacies and therapy adherence, and we continue to innovate in this area.

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