Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

The Problem With Choice

After moving from a very rural area to one of the biggest metropolitan centers in the world, you’d think life would be easier — or at least more convenient — in all respects. Unfortunately, that’s not true in one particular situation in my life. We often need to direct our attentions to some of the most mundane aspects of life. For the past two years, I have been on the search for a really good barbershop. Sounds easy, right? Unfortunately not.

When I lived in Madras, Oregon, population 6500, I went to one barbershop. Every male in town that didn’t want to drive 45 minutes to the nearest town went to this same barbershop. Three barbers worked in this shop, all giving a similar, reasonable quality haircut. They weren’t great, but they did the job.

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As a little background, many years ago I received quite possibly the best haircut of my life. This was back when I was in college, living in Phoenix, Arizona. A local barbershop around the corner had one particular barber. This guy must have been a recent Italian immigrant, because he barely spoke English, perhaps just enough to understand requests for haircuts. He was incredible! Not only did he create a very stylish cut, but he also shaved my neck with a straight razor and warm shaving cream, finishing it off with a warm towel and a neck massage. It was bliss plus an awesome haircut! Ever since then, I’ve been trying to find its equal.

With all this in mind, picture me driving around the suburbs outside of Los Angeles trying to find a decent barber. I’ve been to almost every barber in three local townships. One place was lavishly decorated with plush leather waiting seats, a flatscreen TV, and the works. Of course, the wait was so long I’d blow half my day just waiting. Another place had eliminated the waiting but with the unfortunate result of also eliminating the quality of the haircut. A third place had friendly barbers, but my hair looked like I’d just lost a fight with a lawnmower. The story has been the same everywhere I went.

The large number of choices now available has the opposite effect on my sense of satisfaction. By having only one reasonable choice previously, out of necessity, I made that one choice work. Social psychology explains that now that I have a plethora of choices –perhaps too many- none of them is sufficient for me. My large number of choices is now counterproductive. Experts recommend that in our current world of choices, we seek a middle road, one in which we choose a reasonable but perhaps not perfect option.

This same problem often occurs in medicine. Consider a situation similar to my rural barbershop. Like the barbershop in my town, I was the only podiatrist within a reasonable distance. Whether they liked me or not, patients came to see me (I like to think most of my patients liked me). Like me, they most likely made what they felt was the best of their situation. The converse of this is my current Southern California location in which there are a lot of podiatrists, as well as other specialists. And again, I’ll wager a goodly number of patients have tried out a number of podiatrists for their problems. Anecdotally, I would say I see a larger number of second and third opinion patients outside of LA than I did in rural Oregon, arguing for the similarity of others to my purchasing patterns. One ramification of this is that our patients may be suffering from this overabundance of choice, and they may be overwhelmed when they see us, with subsequent lower satisfaction. Another important consequence may occur during those times when we’re counseling our patients on their treatment options. In the past, I’ve tended to give my patients multiple options. I’ve found increasingly that limiting my patients to fewer options, rather than showing them the entire menu of option, is much less stressful for them.

Fortunately or unfortunately, it’s impossible for any of us to provide that perfect service I described earlier. You can’t be all things to all people all time. It’s just not realistic. In fact, it’s more likely that my blissful barbershop moment was actually a pipe dream made “golden” by the passage of time. Regardless, it’s beneficial to be wary of the dangers of too much choice.