Medical Maximizing-Minimizing

People have a general preference for more versus less medical care, and this can help explain why patients presented with the same evidence reach different decisions.

What do we know already?

Medical maximizing and medical minimizing describe two ends of a spectrum in how people approach healthcare. Medical maximizers tend to prefer more medical intervention; minimizers prefer less unless it is clearly necessary.

Maximizers are more likely to seek tests, screenings, medications, or procedures, even when the benefit is uncertain. This can lead to earlier detection and treatment of disease, but it can also increase the risk of unnecessary tests, overtreatment, and side effects. Minimizers, by contrast, often value watchful waiting, conservative treatment, and avoiding unnecessary medications or procedures. This can reduce exposure to the potential harms and costs of overmedicalization, but it may also delay diagnosis or treatment.

Importantly, neither tendency is right or wrong. Understanding whether someone leans toward maximizing or minimizing may help patients and clinicians communicate more effectively, engage in shared decision making, and choose care that aligns with the patient's preferences.

How was Medical Maximizing-Minimizing orientation discovered?

In the 2011 book Your Medical Mind, Pamela Hartzband and Jerome Groopman proposed that people differ in their general orientation toward healthcare, describing this as a medical maximizing–minimizing continuum. Around the same time, my collaborators and I were exploring a similar question: do people have a general preference for more versus less medical care, and could this help explain differences in healthcare utilization and why people make different medical decisions when presented with the same evidence?

That question led us to investigate whether medical maximizing–minimizing exists as a stable, generalizable approach to healthcare. We found that it does exist and explains variation in healthcare use. It also influences how people interpret evidence and make evidence-based medical decisions.

Further Reading

In the media

Maximizers vs. minimizers: the personality trait that may guide your medical decisions and costs — The Conversation

Publications

Scherer LD, Burke JF, Zikmund-Fisher BJ, Caverly T, Kullgren J, Steinly D, McCarthy D, Roney M, Fagerlin A. (2016). Development of the Medical Maximizer-Minimizer Scale. Health Psychology.

Scherer LD, Kullgren JT, Caverly T, Scherer AM, Shaffer VA, Fagerlin A, Zikmund-Fisher BJ. (2018). Medical maximizing-minimizing preferences predict responses to information about prostate specific antigen screening. Medical Decision Making.

Evron JM, Reyes-Gastelum D, Banerjee M, Scherer LD, Wallner L, Hamilton A, Ward K, Hawley S, Zikmund-Fisher BJ, Haymart MR. (2019). The role of patient maximizing-minimizing preferences in thyroid cancer surveillance. Journal of Clinical Oncology.

Scherer LD, Shaffer V, Caverly T, DeWitt J, Zikmund-Fisher BJ. (2020). Medical maximizing-minimizing predicts patient preferences for both high-benefit and low-benefit care. Medical Decision Making.

Scherer LD, Zikmund-Fisher BJ. (2020). Eliciting medical maximizing-minimizing preferences with a single question: development and validation of the MM1. Medical Decision Making.

Zikmund-Fisher BJ, Shaffer V, Scherer LD. (2021). Promoting reflection on medical maximizing-minimizing preferences may create undesired effects on decisions about low-benefit and high-benefit care. Medical Decision Making: Policy & Practice.

Scherer LD, Shaffer VA, Zikmund-Fisher B. (2022). Maximizing-satisficing and medical maximizing-minimizing are related but distinct dispositions. Decision.