ABC | Volume 113, Nº4, October 2019

Editorial Colafranceschi Behavioral economy and innovation uptake Arq Bras Cardiol. 2019; 113(4):664-666 Physicians, in general, are not trained to be part of a “real team" and tend to behave more like a chairperson, which can increase the tension among team members. Moreover, telemedicine changes the typical doctor-patient relationship, requiring a process of acceptance, by all, of the technological mediation. Beyond that, physicians believe that these technologies may constitute an unsafe medical practice, in part due to the infeasibility in performing a remote physical examination. Overcoming institutional and professional cultural barriers is an essential step in the process of telemedicine dissemination and consolidation. Finally, reimbursement is another issue; physicians feel they will be pressured to care for more patients, dedicating less time to each patient, with lower reimbursement rates. A.3) Patients: what do they want? Are they willing to trade off? Consumers as stakeholders From the patient perspective, although telemedicine may add distinct value to their needs and cheaper access to healthcare, as a health consumer, they may fail to buy the "innovative product" because it may require them to change their behavior. 5 Although it may be cheaper in financial terms, there are psychological costs associated with behavior changes: people irrationally overvalue benefits they currently possess relative to those they do not. 6 B) Behavioral economics and innovation uptake The understanding of the psychology of gains and loss, and more deeply, the concepts of loss aversion, status quo bias, and the endowment effect, 4,6 associated with why the adoption of innovation fails 5 may help propose specific solutions where telemedicine may be acceptable by providers and wanted by patients. 7 Examples of approaches regarding telemedicine that might lead to societal benefit while being fair to physicians are described below: B.1) To make behaviorally compatible products: the development and incorporation of mobile health sensors may offer a sense of safety that is missing to remote physicians. If one can rely on such type of device for feedback of a "remote” physical examination, physicians would feel more secure in guiding and discussing about a patient’s condition using technology mediation. This may minimize physicians’ resistance to telemedicine. B.2) Seek out the deprived individuals (the ones with no access to healthcare): telemedicine has the potential of solving significant current health challenges. In addition to the Brazilian territorial extension, there are thousands of isolated, difficult-to-access locations where healthcare services are extremely scarce, and physicians are lacking. Some physicians are mandated to serve in remote areas (military physicians). Fostering the development of the required infrastructure for the establishment of telemedicine in remote areas will open the doors for communities to have access not only to healthcare but also to other resources (like education). This will promote secondary gains as enhancing local and regional economic progress and may attract physicians and their families to places that otherwise would not be the first choice to live. B.3) Find believers (Millennials): According to Ripton, 8 millennial generation has been changing healthcare by forcing a greater emphasis on technology solutions for healthcare delivery. The development of technology‑enabled solutions targeting this population may speed up and sustain the adoption of telemedicine not only in Brazil but also in other countries. The millennials’ demand will force physicians to adapt (and incorporate) to technology-enabled care, to be competitive in the market. B.4) Strive for 10x improvements 5 : telemedicine benefits should be so great that it would overcome physicians and patients’ overweighing of potential losses. Besides adding efficiency and reducing costs, telemedicine has the potential to expand the actions of health practitioners, integrating them into healthcare services and systems. Also, one can explore the potential savings and share themwith practitioners in a new type of employment relationship and reimbursement model that may improve acceptance of telemedicine among physicians while promoting societal benefits. C) Other considerations C.1) Ethics and legal issues in the digital age: is technology changing faster than expected? Besides what has been discussed above, there is also a lack of synchronization between the vast potential of these technologies and the prevailing ethical and legal apparatus. Contrary to a comprehensive national policy, there is a general scenario of fragmentation, characterized by different norms and standards issued by various bodies and with distinct focuses. 3 Even though a single instrument would hardly reach these goals, the fragmentation is one more hurdle to overcome to achieve the potential of telemedicine. C.2) Infrastructure – Are humans slower than expected? Also, mention should be made of the scarcity of resources and technical expertise, as well as infrastructure issues. Brazil has unequal geographic distribution concerning broadband availability. 3 This means the infrastructure of the broadband data network is one of the most limiting factors to the expansion of telemedicine, particularly, in the countryside of Brazil. C.3) Health services in Brazil Finally, it should be mentioned the precariousness of health services in Brazil, including primary care facilities, outpatient clinics, and even specialized hospital services. Scarce resources, management problems, lack of practitioners, inadequate compensation, outdated facilities, lack of equipment and consumables, among many other aspects, are repeatedly mentioned as the leading causes of such precariousness, witnessed by health professionals and users. This is even worse 665