DEVELOPMENT OF A MEDICAL MAXIMIZER SCALE

Purpose: Groopman & Hartzband (2011) recently characterized individuals as medical maximizers versus minimizers; that is, some people desire active medical interventions even for minor physical ailments, whereas others prefer to avoid medicine unless it is absolutely necessary. The authors further characterized individuals as naturalists vs. technology enthusiasts; that is, some people prefer to address health problems with interventions that are natural, whereas others prefer technologically advanced treatments. However, there are currently no empirical data to support these characterizations. The purpose of the present research is to identify whether these preference dimensions exist, and if so, develop and validate a scale that can measure them.

Method: 606 participants recruited via Amazon’s Mechanical Turk completed an online survey. Mean age was 33 (SD=11; range=18-80), and the majority (81%) were white. Participants responded to 52 questions designed to assess the 2 proposed preference dimensions (maximizer/minimizer; naturalist/technology enthusiast). An exploratory factor analysis identified items that loaded highly onto factors corresponding to these dimensions. To assess predictive validity, participants reported their healthcare utilization and responded to 4 medical decision scenarios.

Result: Analyses showed that 9 questions captured the maximizer/minimizer distinction (Cronbach’s α=.83), and 8 items captured naturalist orientation (α=.86). No factor corresponded to a general preference for technology.

            These preference measures significantly predicted self-reported medical utilization and scenario choices, controlling for demographic factors. Relative to minimizers, maximizers took more medicines (r=0.21), visited the doctor more often in the last year (r=0.36), had more medical scans (r=.010), more overnight hospital stays (r=0.13) and had more lifetime surgeries (r=0.12; all p<0.01). Maximizers were also more likely to choose the more active medical treatments in all of the decision scenarios (all p<0.01). Naturalists were more likely to take herbal remedies and supplements (r=0.52), more likely to have visited an acupuncturist (r=0.15), chiropractor (r=0.12) or healer (r=0.25), and were more likely to refuse medicine prescribed by a doctor (r=0.25; all p<0.01). Naturalist orientation was negatively associated with choosing active treatments for 3 hypothetical scenarios.

Conclusion: We developed and validated a scale that assesses preferences for maximizing vs. minimizing healthcare, and preferences for natural treatments. The maximizer/minimizer distinction, in particular, predicted many aspects of healthcare utilization. We hope that this scale will be used to predict patient outcomes and to better understand real-life medical decisions.