Wait, What? ‘Random Acts’ Have Big Impact on Health
Sept. 27, 2024, David Mitchell (Phoenix) — Anupam Jena, M.D., Ph.D., was planning a career as a physician scientist with a focus on cancer research when he visited the University of Chicago in 2000.
One simple question changed his path.
Faculty noted that Jena had earned degrees in biology and economics at the Massachusetts Institute of Technology and they asked if he would like to earn his Ph.D. in economics. A call was made, Jena got an appointment the same day with the Department of Economics, he applied and was accepted.
“It put me on a very different path than what I had planned when I walked in that afternoon,” Jena said Sept. 26 during a mainstage presentation at the 2024 Family Medicine Experience. “That was a random occurrence. It changed the trajectory of my life, but that kind of thing happens to people all the time.”
Jena’s book Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health examines how unexpected, but predictable, events can affect health. He offered the audience many examples.
Mainstage speaker Anupam Jena, M.D., Ph.D., listens to a response from panelist Hani Chaabo, M.D., FAAFP, ABOIM, second from left, at the Family Medicine Experience on Sept. 26.
When his wife, Neena Kapoor, M.D., asked Jena to watch her run in a road race, he drove toward Massachusetts General Hospital, which was on the route and where he is a professor of medicine and an associate physician in the Department of Medicine. However, streets were closed because of the race, so he headed home.
“My wife asked, ‘What happened to people who couldn’t get to hospital?” said Jena, who dug into that question and found that ambulance response times slowed by more than 30% on race days, and mortality rates among Medicare patients hospitalized along the routes of nearly a dozen marathons increased by more than 10%.
His wife was again the source of inspiration when she got a call to let her know that the Joint Commission was visiting the hospital where she works as a radiologist.
Although audience responses to the mention of the accrediting organization were overwhelmingly negative, it is linked to hospital outcomes that are positive. Jena said research found that mortality rates fell in hospitals during Joint Commission visits.
“If you’re being observed, behavior changes,” said Jena, host of the Freakonomics, M.D. podcast, which discusses the intersection of economics and health care.
Jena asked a panel of family physicians who joined him on stage, and the FMX audience, to look at a series of photos and give their reactions. One photo was from a meeting of the American College of Cardiology. What happens to patients, he asked, when a large number of cardiologists aren’t caring for patients?
The results were surprising. Jena , a professor in the Department of Health Care Policy at Harvard Medical School, worked with colleagues to evaluate outcomes of patients with acute cardiovascular conditions at teaching hospitals during meetings of the American Heart Association and American College of Cardiology, compared with outcomes on nonmeeting days. They found that patients admitted during conferences had lower mortality rates.
Author and Freakonomics, M.D. podcast host Anupam Jena, M.D., Ph.D., signs his book after his presentation about the effects of “random acts” on health.
“Here’s an example of when less is more,” said Jena, noting that stent placements fell by one-third during conferences.
That brought him to another question about numbers. Retailers often set their prices in numbers that end in 99 cents rather than rounding to the next dollar. Why?
Jena said left-digit bias leads people to focus on the first numeral in a series. Thus, a bag of Doritos is perceived as a better deal at $4.99 than $5 even though the difference is negligible.
The same number bias can impact patient care, he said, if a 79-year-old patient is treated as a 70-year-old rather than an almost 80-year-old.
And yes, birthdays matter, too.
Jena’s son has an August birthday, so when the child went to his annual primary care visit in August, Jena was told to bring him in again when flu shots were available.
Coincidentally, Jena got his own flu shot in September. When a colleague questioned why he got vaccinated so early, Jena began to ponder the optimal timing for flu vaccines.
He found that kids are likely to get their flu shots in the same months of their birthdays, aligning with their annual visits. Thus, kids with September birthdays get their shots earlier than kids with winter birthdays.
Jena said kids with fall birthdays are far more likely to get flu shots than kids with summer birthdays, and children in the latter group are more likely to get the flu. Kids with October birthdays were the least likely to get the flu. Jena, an internal medicine physician, said those results suggest that October might be the sweet spot for flu shots.
The presentation included several anecdotes related to driving, including data from speeding tickets that showed psychiatrists are the fastest drivers among doctors and drivers who have the same first name as the officer who stopped them are less likely to get a ticket.
Meanwhile, a 2000 study of the brains of London taxi drivers found that their posterior hippocampi were significantly larger relative to those of control subjects. The authors stated that the “posterior hippocampus increases in volume when there is occupational dependence on spatial navigation.” Fast forward a few decades, and Jena said recent studies indicate that taxi drivers had lower rates of mortality related to Alzheimer’s than people in other occupations.
What that means, he said, isn’t yet clear.
But one driving fact is clear: When a new movie debuts in the Fast and Furious franchise (now up to 11 movies) speeding increases.
“The name of the movie is Fast and Furious, not Slow and Deliberate,” Jena said. “What you see affects your behavior.”