The impact of time-preference on Clinical decision-making

Abstract: Time preference is a concept arising out of economic theory that suggests that individuals attach greater value to the present than the future. One definition for time preference is the “relative weight an individual gives to present utility compared to future utility.” Against a backdrop of rising healthcare costs driven, partly, by lifestyle factors and preventable diseases, there is a growing field of inquiry examining how time preferences drive healthcare related choices and outcomes. In the clinical context, providers encounter patients who make choices that seem irrational and lead to questions about their ability to guide their own care. This presentation will explore the hypothesis that time preference is a factor which shapes the way that patients and providers make decisions about healthcare and may offer an explanation for apparently irrational choices I provide several reasons to think that physicians likely demonstrate a lower time preference than many of the patients they serve, and this may be a reason for conflict over medical goals as well as non-compliance with the provider’s guidance. Within the constellation of factors that shape patients’ decisions, I will assert that time preference is a factor worth considering. Such differences may offer an additional tool for understanding patient non-adherence. As patient disagreement with or non-adherence to provider recommendations seems to be a driver of physician’s moral distress, this paper will close with an exploration of the role of clinical ethicists in assisting teams with navigating this type of discordant situation.

Keywords: Time preference, Treatment non-adherence, Conflict over plan of care