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The Impediments of Choice Making: Or How More Might Not Be Better

In 2004 a psychologist named Barry Schwartz wrote a book entitled The Paradox of Choice, and created a firestorm in consumer theory. The idea of the paradox of choice is that when you are bombarded with a lot of choices you have a much harder time making a decision, anxiety about your choice rises, and often your decision-making suffers, which can make you feel less happy with the end result. What started this idea was a consumer study, done with jam, set up like this: in a gourmet food store there was a table with jams to sample from – every few hours they switched the number of sample jams from twenty-four to six. When people had the twenty-four jams to choose from only three percent ended up purchasing a jam and when they had only six, thirty percent ended up with a purchase. This study changed the way people thought about consumer habits and since then studies have shown this to be true for people in a wide variety of situations including choosing medical plans and house remodeling options. Of course, with all things in science there has been a backlash with people trying to re-butt the idea and creating scenarios where it may not work. I can’t help but shake my head at the irony of this- now we have more choices in thinking about whether having many choices is a good thing or not!

I know what my experience tells me. Just yesterday I was perusing for a gift and when I typed in what I wanted, the site gave me 1,435 choices. I decided to look for something else.

I’ve noticed this in my journey with juvenile rheumatoid arthritis. When I was young, the only medical options I had were aspirin, steroids, and a few disease-modifying drugs. There were no biologic drugs, no talk about diet, supplements, alternative care, or any of the myriad of things we now hear about every day. I didn’t have advertisements bombarding me every time I turned on the television or opened a magazine touting a new drug. I was a lot less anxious about my decisions back then.

I, for one, am glad about this new reality. For me, options are good, even if they come in the form of too many because when I was living in a medical desert as a kid, I could have used a few more options when things got bad. People today are much less likely to end up with the fused joints and permanent joint damage I live with because of them.

What concerns me, though, is the worry that often comes with the choices I make, that nagging feeling that if I had made a different choice my outcome would have been better. A few months ago I took my doctor’s advice and began a new biologic drug. As with most RA drugs, along with the improvement in my joints came side-effects. I found myself wondering if I’d made the right decision, thinking, “maybe I should have gone to a Naturopath instead,” whenever I was dealing with a new side effect.

In order to live well with rheumatoid arthritis you can’t second guess yourself, this I know. I also know that people with RA are huge consumers of health-care products and that this area is growing every day. So, in order to decrease my anxiety about the choices I’ve been making I decided to find out how to make better decisions. A quick google search led me to some really good information. I learned that I was already doing much of what the experts recommend which helped me with the one cardinal rule I was breaking; whatever you do, once you make a decision, don’t second guess it.

Some other advice was to learn from your past, keep your decisions aligned with your values, watch the quality of information you are looking at in order to avoid misinformation and to try to put large amounts of information into smaller categories to help limit options. I think this is especially good advice for people who live with rheumatoid arthritis because we are making hard choices about our health and well-being on a regular basis and we live the consequences of those decisions. Moving forward I’m going to remember this advice and the next time a big decision comes my way I will remember to be glad I have a choice to make as I move in a new direction without looking back.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Lawrence 'rick' Phillips moderator
    3 years ago

    When confronted with overwhelming choice, I ask my wife. When she is confronted with the situation she asks our dog. our dog Samantha has no choices so to her all choice is like a milk bone. She likes whatever Sheryl buys. See how that came back around? LOL

    I do think we rely on experts to help us make choices. In my case, (like most men) our choices are decided by our female partners and that almost always works best.

  • Richard Faust moderator
    3 years ago

    Thanks for writing Rick. You bring up a great point about bringing in experts. The science side of me wants to examine the different aspects of choice theory and the studies about choice optimization (hint: the original work with the jam jumps from a relatively very large number to relatively few – if you alter the numbers more it changes the dynamics), but you bring up the far more important point about the difference made by adding information. Here is another article on choices:

    As Kat gets to at the end of her article, getting more choices has been better for RA patients because there is also more information on the how and why different treatments work.

    In this article Kelly Mack, a contributor here and full disclosure – my wife, looks at the evolution of RA treatments and one of the things that jumps out is the fact that years ago even the doctors where often flying blind:

    Hopefully as we learn more about the genetics of the condition and move more towards personalized medicine the choices will actually become easier. Best, Richard ( Team)

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