First Impressions Matter

First Impressions Matter

In Thinking Fast and Slow, Daniel Kahneman describes a research study that shows the power of the halo effect. The halo effect is the phenomenon where positive traits in a person outshines the negative traits or characteristics of the individual, or cause us to project additional positive traits onto them. For example, think of your favorite celebrity. You know they are good looking, talented at whatever they do, and you most likely also ascribe a number of positive traits to them that you don’t really have evidence for. You probably believe they have the same political beliefs as you, that they probably pay their taxes and don’t litter. If you discovered they did one of these things, your brain would want to discredit that information, or you might face some cognitive dissonance as you square the negative characteristic with the fact that the person looks good and is talented.

 

The study Kahneman references shows the power of the halo effect by giving people 6 descriptions of a fictitious person. Some people were shown 3 positive characteristics followed by 3 negative traits. Another group of people were shown a different fictitious person, with the same 6 traits, but listed in reverse, with the negative traits first followed by the positive. Kahneman writes, “The sequence in which we observe characteristics of a person is often determined by chance. Sequence matters, however, because the halo effect increases the weight of first impressions, sometimes to the point that subsequent information is mostly wasted.”

 

The study shows that first impressions matter a lot, even when we are not actually meeting someone in person. When the first thing we learn about a person is something positive, it can be easy to overlook negative traits that we discover later, and this is true in reverse. This idea is part of what drove Malcolm Gladwell to write his new book Talking to Strangers. I have not read Gladwell’s book, but I have listened to him talk about it on several podcasts. He discusses the death of Sandra Bland, and the interaction she had with law enforcement that led to her arrest and subsequent suicide. First impressions matter, and the first impression she made on the police officer who pulled her over was negative, shaping the entire interaction between Sandra and the officer, and ultimately causing her arrest. Gladwell would also argue, I believe, that first impressions can be formed before you have even met someone, simply¬† by absorbing racial or other stereotypes.

 

Gladwell also discusses Bernie Madoff in his book. A savvy conman who relied on the halo effect to swindle millions. He charmed people and seemed successful, so people who trusted him with investments had trouble seeing through the lies. They wanted to believe the positive traits they first observed from him, and any hints of fraud were easily missed or ignored.

 

The best we can hope for is awareness of the halo effect, and remembering how much our very first impressions can matter. How we put ourselves forward can shape the interactions we have with others. But we can remember to give people a break, and give people second chances when our first impressions of them are not great. Remember to look beyond the first observed trait to see the whole picture of other people in your life, and try to set up situations so that you don’t judge people immediately on their appearance, and can look further to know and understand them a little better.
The Cost of Outliers

The Cost of Outliers

Malcolm Gladwell is well known for his book Outliers, about people who become extremely successful thanks to intense practice, good luck, and supportive situations that enable their early practice and skill development. If you have read his book, you probably have at least a little exposure to the idea that some people are unique and can have a surprising influence on the world. But one area you probably haven’t considered with the impact of outliers, unless you study healthcare economics, is in medical spending.

 

In his book The Opioid Crisis Wake-Up Call, Dave Chase explains the issues with outliers in our system. “Six to eight percent of plan members are spending 80 percent of the plan dollars,” Chase writes.

 

We probably imagine that our healthcare costs are so expensive because so many American’s don’t eat well and don’t exercise. I have argued in the past that we don’t support a universal healthcare system in our country because many people think the problem is that others are not taking responsibility for themselves and are simply fat and lazy, costing more for the rest of us. The reality is that a huge amount of our total healthcare spending, as much as 80% according to Chase, is from a tiny percent of the population. Our outliers are driving the cost of healthcare up at an alarming rate, and it is not simply because these outliers are fat and lazy.

 

The people who spend the most on healthcare mostly have rare diseases, congenital conditions, or need extreme emergency acute care. Chase writes, “They tend to have complex health problems, usually with multiple comorbidities.” Because we don’t recognize that most of our spending goes toward outliers, and because we are biased against a vision of fat and lazy people, we adopt policies that bankrupt these outliers who often were simply born with bad luck when it comes to health.

 

What is really detrimental to our system is that these outliers are often misdiagnosed. Chase writes, “In any given year, about 20 percent of the outlier group is completely misdiagnosed. This means that about 16 percent of plan dollars each year are being wasted on treatments for diseases the patients don’t have.” It will always be difficult to treat outliers. They are not typical patients, and have multiple health issues that interact in complex ways. But because we don’t make their care easy and because healthcare in the United States has so many barriers, we end up failing this population, and the errors and failures mean that we waste a huge amount of money and resources in their care. It doesn’t just cost the individual, but everyone on the healthcare plan.