Tag Archives: health

Using your BRAIN to negotiate with the doctor

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Two of my most common refrains on negotiation are these: Much of life is a negotiation, and a negotiator’s success depends on what they do before negotiating. These two conclusions come together in a common negotiation we all face routinely: a trip to the doctor’s office. Simply put, understanding a doctor’s visit as a negotiation and preparing for it accordingly can make life negotiable.

But wait—why’s a doctor’s visit a negotiation? Because anytime we depend on others to achieve our goals, we’re negotiating. Since we surely depend on the doctor to achieve one of our most important goals—our own health—it’s a negotiation. And if a doctor’s visit is a negotiation, then you need to prepare for it for the same reason you’d prepare for any negotiation: because much of the outcome is predetermined by how well you understand the situation beforehand. But here’s the good news: the same acronym you’d use to prepare for any negotiation—BRAIN—applies to a doctor’s visit in spades. To see why, let’s consider each of the five letters in turn:

  • B=BATNA (best alternative): What’s your alternative to this particular doctor if you don’t get a satisfactory diagnosis or treatment? Seek another doctor, thereby spending more money, taking more time, and generating more incomprehensible bills in your mailbox? Unless you’re seeking to solve a serious medical issue, that doesn’t sound like a very attractive BATNA. So you’d better do what you can to achieve your objectives in this visit.
  • R=Reservation price (bottom line): What’s the least satisfactory outcome you’d accept from this doctor before seeking out another? If he or she suggests watchful waiting instead of active treatment, will you consent? If he or she is too busy to offer an adequate answer to your most important question, is that gonna work for you? Either way, you’d better ask beforehand to avoid walking out in a state of severe dissatisfaction.
  • A=Aspiration (goal): What’s the best possible outcome you could hope to obtain from this visit? Are you shooting for a particular medication, referral, or treatment plan? You need to know beforehand because the doctor may not think of it or be motivated to offer it unless you ask.
  • I=Interests (underlying motivations): What do you fundamentally need to achieve from this visit? Is it really the specific medication, referral, or treatment plan, or are you ultimately seeking to fix the aching shoulder, wobbly ankle, or elevated blood pressure? It’s important to keep your focus on the underlying problem rather than the surface-level solutions, as the doctor may well offer an even better solution. If so, you should probably listen rather than sticking slavishly to a suboptimal solution.
  • N=Negotiation counterpart (the doctor): How’s the doctor likely to answer the preceding questions? In particular, what’s their alternative to you? Probably to see the next patient. And what’s their bottom line in response to your requests? They’d probably refuse to offer you something risky, ineffective, or likely to require undue effort on your part or theirs. And what does the doctor hope to achieve in your visit? Probably to reach a quick diagnosis and make a simple recommendation that helps you our immensely. And finally, what’s the doctor’s underlying interest? For good doctors, hopefully to make you as healthy as possible. So you see, by putting these answers together, that the doctor surely wants to help but probably prefers to do so not just effectively but efficiently. And that should you immensely in framing your requests.

So visiting a doctor is not so different from buying a car or negotiating a raise. In all cases, you need something important from someone else. And in all cases, using your BRAIN beforehand is critical to achieving your objectives, be it fancy wheels, a fat salary, or a healthy you.

Negotiating Life’s Non-Negotiables

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My posts routinely suggest that life becomes negotiable when we apply some simple scientific principles from negotiation research. But we all know that not everything’s negotiable. The weather (it’s been raining in Maryland for months), our own health (we all face the fickle hand of fate), the state of American politics (nuff said). Some things just can’t be negotiated.

But that doesn’t mean they’re not negotiable!

Indeed, non-negotiable issues often force us to negotiate with ourselves, and those same scientific principles can still make our own intra-individual negotiations more negotiable. To see what I mean, consider the following five principles as they relate to negotiations with ourselves:

  1. Interests: Negotiation research advises you to ascertain your counterpart’s interests (their underlying needs, desires, and priorities). But in the face of circumstances we can’t control—say the perpetual cloud hanging over my home state—we would all do well to examine our own. Is it in our own interests, long-term, to worry about the weather? Probably not. (See health point above.)
  2. Integrative solutions: Negotiation research emphasizes that outcomes don’t need to hurt one party to benefit the other. Likewise, we’ve all heard that every cloud has a silver lining. In the case of Maryland’s many clouds, the silver lining has been my ability to focus on writing rather than the many distractions associated with a sunny day. So Mother Nature’s perverse pleasure in raining on me meshes well with my very appropriate pleasure in being productive.
  3. BATNA: Negotiation research urges to consider your Plan B. In the case of uncontrollable events, that exercise could actually help you realize that the event is a teeny bit negotiable. What’s your alternative to complaining about the political state of our country? Finding a way to get involved and change whatever small corner of it you can, as many people have (recently).
  4. Ratification: Negotiation research teaches us, when we’re deep in the heart of a contentious negotiation, to step away and think about it before acting rashly. Similarly, people who happen to get all worked up about politicians or entire branches of government often find it useful to consider another topic before taking to Twitter.
  5. Negotiating in teams: Negotiation research teaches us that two heads are often better than one at the bargaining table. When it comes to life’s uncontrollable and sometimes insurmountable challenges, two heads are surely better than one. Indeed, finding a way to obtain some social support and tackle the non-negotiable together is probably the most productive way to make it negotiable after all.

These are just examples—and perhaps a little tongue-in-cheek—about the relevance of negotiation research for the intra-individual negotiations that often attend non-negotiable events. But the serious point is that many of us are our own toughest negotiation counterparts. Life becomes negotiable when we realize we don’t have to be.

What’s up, doc? Negotiating in healthcare

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Most of us spend more on healthcare than we’d like to—more, in some cases, than our annual car or mortgage payments. That being the case, why do we spend so much time negotiating the terms of our cars and houses, and so little the terms of our healthcare?

Frankly, the negotiation professor in me just doesn’t know. From my perspective, a few simple principles from the research literature on negotiation can make our healthcare much more negotiable. Just a few illustrative examples:

  1. Setting high aspirations. Negotiation research consistently shows that those who set and stick to aggressive goals tend to achieve better outcomes. With respect to our own bodies, though, I suspect many of us are dissuaded from our goal of ideal health when a well-intentioned doctor tell us “there’s nothing wrong,” or “you’re just fine,” even when we know there is and we’re not.
  2. Reiterating our core interests. Negotiation research shows that the most effective negotiators are those who hew to a consistent script—reiterating their core problem or motivation as consistently and repeatedly as possible. This seems particularly important in healthcare, when we often have to answer the very similar questions of a seemingly endless series of people. On a visit to the ER, for example, we might have to state our symptoms to the front desk, triage nurse, attending nurse, doctor, radiologist, and so it goes. The more consistent our message to each person, even in response to slightly different turns-of-phrase, the better our chances of proper treatment.
  3. Cultivating an alternative: The best negotiators always develop an alternative possibility—another car or house they’d be willing to buy, for example. Negotiating the terms of an alternative affords them power in their primary negotiation but also, importantly, helps them learn about whatever they’re negotiating. What price should I really offer for my preferred Corvette? Some of us cultivate an alternative in healthcare by obtaining a second opinion. But I suspect that some of us don’t because we think the doctor will get offended. Assuming we’re at least as motivated to learn about our health as our cars, I’d suggest we should.
  4. Asking questions: The best negotiators ask a lot of questions. Indeed, they probably use their listening ears more than their speaking lips. Well, few contexts are quite as rife for questions as the cryptic explanation of benefits. $392.54 for an octowhatgraphy with Dr. Whosehisname? I don’t know about you, but I’ve found that calling the insurance company and asking about it not only helps me mitigate confusion. It also turns up quite a few clerical errors that end up saving me money.
  5. Just asking: Asking a lot of questions is great, but even more basic is asking in the first place. The best negotiators are those who simply ask for whatever they need or want rather than expecting their counterpart to guess. But I suspect that few of us really ask for what we want in healthcare, mainly because we think we can’t—especially with a high-status doctor across the table. Lower prices, less invasive procedures, fewer unnecessary appointments: it’s all worth an ask if it matters.

In short, few aspects of our own lives are more important than our health. So why not do what we can to negotiate a healthier deal?