Over the past several years, there have been a plethora of books which begin to address issues concerning human behavior, decision making, and how one might influence behavior. In our work in health care, as we continue to talk about the transformation of our health care system, we will be expecting an increased level of engagement, activation, and direct participation from our patients. Within the construct of the medical/health care home there is an explicit expectation that the success of these efforts (and many more) will require behavior changes, mindset alterations, and decision capabilities not presently an innate part of the process of health.

While we have postulated about the underlying mechanisms of human behavior since the time of Plato, it was for the most part based on hypotheses, and assumptions about the functioning of the human brain and how it was manifested in human actions. In fact, I suspect that many clinicians trained in my era (Yes, I’m a baby boomer) have almost no underlying framework for understanding the “science” of behavior change. It was an assumption for many in our profession, that the fact of telling a patient to take an action was sufficient to induce the change needed, and that a lack of initiation of that “order” was tantamount to non-compliance on their part.

In How We Decide, Jonah Lehrer delves into the research into neuroscience, and in an easily readable, but compelling style, begins to link that research to the specific aspects of decision making and behavior change that will not only be useful, but necessary for us to consider as we move patient centered care forward. Relating sports anecdotes (quarterbacking in a Super Bowl) to buying a house, purchasing a stock, and even the life and decisions of a poker player, Lehrer paints a vivid picture which begins to help us understand the challenges we face in supporting shared decision making, patient engagement, and behavior change.

While his book focuses on specific examples of using this science in sports, business, and the military, it provides those of us in health care with information which I believe will be critical in understanding how we need to craft and present our recommendations and plans to those we serve—our patients.

Superimposed on books like Nudge, Predictably Irrational, Sway, Drive, Switch, this is a great juxtaposition of the underlying neuroscience of behavior change, with the concrete actions it leads to. If, after reading this review, you purchase the book, you’ll be demonstrating some of the behaviors he speaks of—but I’ll let you read the book to discover that bit of information.