Steven H. Woolf at Virginia Commonwealth University contends a major contributor to the alarming rise in health care costs is patients' unrealistic expectations about the benefits of health services.

Confronting these beliefs, he asserts, is a potentially more effective way to bend the cost curve than many current reforms. He writes, "If patients and clinicians widely hold that a procedure is life-saving and harmless, any reform is unlikely to curb demand until those misconceptions are addressed."

Yet, he points out, such beliefs and behaviors are difficult to change with facts alone because they are shaped by affective influences:

beliefs and fears;
vulnerability; faith and trust;
longstanding routines; personal experiences;
messages conveyed by advertising and medicine;
and the advice, testimonials and transmitted knowledge imparted by trusted sources.

He points to encouraging hints of a shift in societal attitudes about the overu-tilization of medical services, over-diagnosis and profligate use of screening tests, and he calls on the medical profession to act as a change agent in bringing more realistic expectations to patient care.