The Power of Pre-Suasion

A casual observer might argue that much of what a physician does is, in effect, sales. We are often trying to talk someone into something, a medical work up or treatment, or out of something, like self-destructive habits.

Docs have various tools at our disposal to “make the sale,” chief among them the authority of our degree — that’s MD, not “provider,” by the way, and our knowledge of scientific evidence. “We know this, therefore it is only reasonable that you do that.” But people are complicated, even ornery in their skepticism and often passive resistance. We know that you can bring a horse to water, but you can’t make him drink sometimes.

Based upon my contact with some recent medical grads, I see that docs are not really adequately trained in persuasion techniques. That’s further troubling because there really is a large amount of research available to help us get our patients to take maximum advantage of what we know and recommend.

So along comes Robert Cialdini’s new book, Pre-Suasion, to open this barely ajar door. Happily, it is quite readable and each page seems to be full of surprising, documented revelations.

His basic theme is that there is substantial evidence to suggest that how one prepares, or frames, one’s approach to the question, request, or statement largely determines how successful the response will be. To put it in his words, “Even the finest seeds will not take root in stony soil or bear fullest fruit in poorly prepared ground.” Put in yet another way, by guiding preliminary attention strategically, you increase the likelihood that a given technique will work.

His first point is that you cannot be persuaded of something until you are paying attention to it. He calls these “privileged moments.” He bases this idea on the human tendency to assign undue levels of importance to an idea as soon as one’s attention is turned to it. And what gets our attention the most is a threatening situation, or sex, or the unusual or unfamiliar. Bathed in the usual noise of our day, we are drawn to anything that stands out. Like seeing a doctor.

A good non-medical example of how this all works can be seen in our current political season. By manipulating metaphors, one can influence policy. For instance, if a local increase of some sort of crime is portrayed as a “wild beast rampaging through our city,” you might be inclined to follow a “catch and cage” solution.

On the other hand, if the self-same uptick in crime is described as a “spreading virus infecting the city that must be stopped,” you might look for a “remove unhealthy conditions” solution. See how it’s done?

I could go on and on because this book is so fascinating and useful, but I will leave you with a citation to another author. Sam Snead, the Hall of Fame golfer, once wrote a book on various gambling games for the golf course. His main point? All bets are won or lost before the first ball is struck; the key is how you set up or structure your transaction before you start. Pre-Suasion in action.