Cognitive economics: the struggle for our patients’ attention

It’s a finite resource with powerful rivals. But we need to win.

More and more, I’m engaged in a showdown for my kids’ attention. I’m up against a smartphone and don’t stand a chance. All too often I’ve gotten the monotone “Yeah, Dad,” in response to my attempts to communicate. Now, on family trips, Internet use is usually limited to an hour a day. The first day I can see the withdrawal in their eyes, but the next day it’s as if they came out of a movie theater into the afternoon sunshine — squinting and dazed as they look around and reconnect with the world around them.

We physicians are not much better. At medical meetings, lectures used to be an hour long. Now they run 12 to 20 minutes, tops, while many in the audience sit with phone in hand. Look at our TV screens with live video on the left, a chart or graph on the right and a crawl across the bottom.

How do we stand a chance engaging patients in our office? It’s a rare one who is not carrying a smartphone to suck up their attention. We place signs requesting patients not use these Internet-connected phones in the exam room — usually to no avail. We can’t take away their smartphones.

So, what can we do? Cognitive economics to the rescue.


Economic principles are woven into the routine practices of the office. Each day or month, we are looking at collections, costs and budgets. Also on our plates: managing provider and staff time, along with the number of patients possible to see in each clinic. This is all a traditional economic model — consider the amount of time or money one has to optimize, then maximally spend or utilize it. However, some more abstract resources that becoming more relevant in our practice — such as our patient’s attention. Cognitive economics can help us first identify this dynamic then strategize an approach.

The quest for attention When patients visit our office, we are competing for their attention. It’s a competition that has become more arduous over time due to the increasing number of distractions patients have. Instead of coming in focused on concern for their eye problem, as in the pre-smartphone, pre-Internet, pre “play date” days, it is now more common to find that they are preoccupied, often having many places to be that day. Despite the signage in your office, their smartphone is probably on, keeping them connected to their schedule, the news, games or a “life crisis.”

The result? You may walk into the exam room to find them not exactly attentive to the information you provide. This is especially troublesome given the increased patient education necessary about the evolving technology for their conditions, such as premium IOLs for cataract surgery or MIGS procedures to manage glaucoma.


Knowing you have rivals for your patient’s attention allows a practice to strategize by being competitive. Begin by designing a patient experience to capture their attention. Here are some considerations:

  • Emphasize the importance of the exam. We tend to spend most of the exam downplaying concern. A doctor may tell a patient undergoing treatment for glaucoma that he or she will not go blind or that cataract surgery is a 10-minute outpatient procedure. That wet AMD is rare and can be prevented and treated better than in the past. This alleviates anxiety, but it can also reduce the patient’s attention. Patients may hear this and be less likely to use drops, come for follow-up, take AREDS vitamins, etc. Consider providing balanced information about the potential impact of not heeding your advice. For example, include in your discussion something like, “You only have one chance to have cataract surgery and pick your implant type or have it done with laser technology.”
  • Minimize other distractions during the visit. New patients are often exhausted by the time they check in, fill out several forms, get their insurance card copied and pay their co-pay. And they haven’t even made it to the exam room! Providing necessary documents in advance by e-mail or snail mail enables patients to complete them at home and will conserve time and attention when they come in. Another attention drain is overwhelming patients with information in waiting or dilating areas. Showing videos about eye conditions, cable news shows or financial information can stress a patient out. Instead, play music in the waiting room to soothe your patient. In my office, when patients are in the dilating room, we play re-runs of “Seinfeld” and “The Carol Burnett Show.”
  • Spoon feed information. Manage your patient’s experience during a visit with a focus on maximal utility of their attention. Control information to deliver it in a fashion the patient can easily absorb and digest. Too much information too quickly will cause a patient to shut down. Decide how the practice’s work flow will deliver information. Perhaps IOL types are discussed in depth only if the patient and doctor decide to have cataract surgery. Then, a patient will listen more closely because the surgery is a reality. Another example: During a glaucoma evaluation, have the staff educate the patient during testing. Explain before the field test how it helps in detecting or following glaucoma. Educate the patient having an OCT of the nerve’s or macula’s role and how the technology helps in diagnosis. This fosters buy-in from a patient to perform better during testing and be more engaged when the doctor reviews the results during the exam.


With a new understanding of the scarcity of patients’ attention, we altered our approach for the cataract evaluation. All patients are mailed registration forms to fill out at home. They are told to schedule two hours for the visit and that they will be dilated. During dilation, they are given a form, explaining femtosecond laser and premium IOLs, that take most patients under one minute to read. We no longer give surveys or show educational videos, opting to show the “Seinfeld” reruns while they dilate.

I discuss the surgical choices only once they decide to schedule cataract surgery. I emphasize that this surgery is only done once and they will know which implant is best for them, but that it is an important decision because I usually cannot replace the implant later.

Attention is a struggle. Our world is full of distractions. A strategy to tackle this in your office using cognitive economics is a good start. Gosh, even a writer can get distra … Hey, look, a squirrel! OM