The Therapy Scales: Increased adherence through participatory decision-making

Fast thinking, slow thinking

The Therapy Scales are based on two theoretical pillars. The first pillar is behavioural economics. In his bestseller »Fast thinking, slow thinking«, The Nobel Prize winner Daniel Kahneman writes that we think in two different modes: Our everyday mode is fast thinking. In this mode, our brain uses patterns of behaviour and decision-making that we have learned in the past, even if they do not fit the current situation. Behavioural economics refers to these patterns as heuristics. Basically, they are rules of thumb that are precise enough to help us navigate through the day. The other mode is slow thinking. Slow thinking is algorithmic thinking: it illuminates existing facts without emotional artefacts, enables the unfiltered definition of options while evaluating them »mathematically« and critically weighing up the pros and cons. But our brain is reluctant to switch to this mode - it tries to get through the day with heuristics, which usually works as long as the situations to be dealt with are not too complex. However, heuristics become a decision trap when we apply them to complex decisions. With the Therapy Scales, a doctor can help his patient switch to the slow thinking mode, leading him or her through the decision process step by step.

Applied learning theory

The second theoretical pillar of the Therapy Scales is learning theory. Our brain finds it difficult to assess the probabilities and risks that play a role in therapy decisions. The Therapy Scales give the physician the possibility to visualise the patient's risks, thus making them intuitively understandable. The use of the Therapy Scales is applied learning theory, not only because the information is visualised, but also because the patient is actively involved, in the sense of the well-known quote from Confucius: »Explain to me and I forget. Show me and I remember. Let me do it, and I understand.«

How do the Therapy Scales work?

Mr Müller, your blood pressure is too high and you weigh too much. My biggest concern is that you could soon develop diabetes. If you do not change anything, you might have a heart attack or stroke, too. I want to show you this with the Therapy Scales.
It is very likely that you are not satisfied with the result the scales show. But there is a second aspect of the scales. That is what we are going to deal with next.
Please choose the measures you believe you can definitely achieve. Select the measure which you are most certain of accomplishing, and drag it to the greatest weight. Drag the measure you think you are least likely to achieve to the lowest weight.
Mr Müller, you can see that the measures are not yet sufficient to reach the green zone.
Choose a measure for which you are willing to be a little more disciplined, then increase the weight accordingly.
Now, let us see how that affects your risk. I am almost satisfied with the results.

Conclusion

The Therapy Scales are an instrument with which the doctor can guide the patient towards the correct therapy decision step by step. The patient is actively involved in the process. The principles of the Therapy Scales are to make probabilities comprehensible through visualisation, and to precisely define criteria that influence the patient's decision. A further effect of the method is that the doctor gains a better understanding of the actual motives of his patient and can, therefore, exert influence in a more targeted manner.