Monday, May 06, 2013

How Colonoscopies Are Like Home Renovations -

It's a law of nature: Everyone who undertakes major home renovations ends up loathing their contractor. When I was recently redoing my kitchen and bathroom, I finally figured out why. It has nothing to do with the contractor's honesty, quality of work, punctuality or the mess they make. It's about behavioral economics and human psychology — in particular, the unusual way that we assess pain.

In the early '90s, the psychologist Daniel Kahneman and his colleagues did a series of experiments that revealed how people remembered the pain of a situation. In one experiment, participants held a hand in an ice-water bath (of 14 degrees Celsius) for 60 seconds — a pretty painful experience. To be precise: an 8.3 on a 10-point pain scale. In a second experiment they held their hand in the same ice-water bath for 60 seconds and then for another 30 seconds, during which the water was warmed just 1 degree.

This small increase had a big effect: afterward, when people were asked which experiment they would prefer to have repeated (for money), two-thirds preferred the second — the experiment that lasted longer and, therefore, had more overall pain.

Dr. Kahneman's conclusion was that people don't evaluate the pain of an experience by summing up the overall total. Instead, they remember the pain at the very end — and whether it got better or worse.

This was confirmed in 2003 by another experiment by Dr. Kahneman, who won the Nobel Prize in 2002, and his fellow researchers, concerning the pain associated with colonoscopy. The patients in the study underwent the usual procedure, but one group experienced a slight change at the end. How to put it delicately? After everything was finished, the tip of the colonoscope was left resting in the rectum for up to three minutes before being removed.

Afterward, when all the medications wore off, patients evaluated the pain of the procedure. Surprisingly, those who had the colonoscope in longer on average remembered less total pain. And this just wasn't a matter of self-reporting: over the next five years, they were also 18 percent more likely to return for a repeat colonoscopy — increasing the opportunity to reduce deaths from colon cancer.

Besides the fact that remodeling can often feel like putting your hands in an ice-water bath, what do these experiments have to do with one another?

The end of a remodeling job is always a terrible experience. A lot of little things need to be taken care of — some outlet doesn't work, the countertop wobbles just a little, the door doesn't lock. In my case, the three problems were a towel warmer that lacked an on-off switch, a shower that didn't work properly and a loose piece of molding.

Repairing these types of minor problems is costly for the contractor. Sending out an electrician for one outlet or the plumber to fix one faucet is unplanned for and inefficient, and really eats into the profits. Consequently, contractors balk at doing the repairs, waiting to aggregate a bunch before fixing one. For the homeowner who has just spent what seems like a fortune on the remodeling job, each problem and delay is enormously annoying. (Indeed, my molding is still loose.)

As Dr. Kahneman's experiments show, the pain at the end — whether it is getting better or worse — plays a disproportionately large role in determining how we remember an experience. So the fact that this game of glitch, procrastination and evasion comes at the end of the remodeling job means that we all end up hating our contractor, even if most of the job has gone smoothly.

So what should contractors do? They could promptly repair every problem the moment a homeowner identifies it. But that would be costly and seems unlikely. Perhaps instead they should consider picking something the homeowner really cares about and exceeding expectations on that one repair — but only at the very, very end. One friend told me that her contractor gave her an espresso machine when the job was finished. Even if she ultimately paid for the gift, her memories of the experience were sweeter than mine.

The good thing is that, like a colonoscopy, once the remodeling is over, you won't need another one for years.