How to floss (a hacker’s guide to completing unpleasant tasks)

There are two kinds of people in the world: those who floss their teeth every day, and those who wish they did.  For most of my life, I was a member of the latter group.  I never flossed–it took too long, was unpleasant, and I didn’t feel I received any benefits from the process.  I ignored my dentist’s  recommendations to floss, and the free dental floss I received after each visit settled, unopened, at the back of my bathroom drawer.  My wife–an obsessive flosser–eventually tired of reminding me to floss every night.

One night, purely by chance, I was watching an interestingTED talk on my phone when it was time to brush my teeth.  I took the phone to the bathroom, and continued watching the video while I brushed.  I still had 5 minutes of video left, and wanted to finish watching it before going to sleep.  How to spend the time?

You guessed it.  I found the dental floss at the back of my drawer and started flossing.  I flossed until the video finished, and then I went to sleep.

The next night, while brushing my teeth, I saw the dental floss staring at me, now that it had an upgraded seat on the  bathroom countertop.  I selected another TED video, and began flossing.  This ritual continued for the next few nights.  Some nights I would watch an entire TED episode, other times I watched shorter segments.  Without really thinking about it, I became a daily flosser.

Why is this important?  Well, in addition to the inherent benefit of flossing to maintain good oral health  (especially in light of the evidence that gum disease may increase your risk of rheumatoid arthritis), this technique can be used to do other unpleasant but necessary tasks, such as taking medications, exercising, and even taking out the garbage.

As a rheumatologyfellow, I often prescribe medications which can have unpleasant side effects.  Methotrexate, for example, can cause nausea.  Biologics (such as etanercept, adalimumab, and anakira) are given by injections, which can be uncomfortable and painful.  However, these medicines are essential to maintain good disease control for many patients with rheumatic diseases, despite their short-term ills.

Research has shown that up to 50% of patients don’t take their medications as prescribed.  Much has been done figure out why, and what we can do about it (from a patient, provider, systems, and policy perspective).   There is hope (hype?) that medical apps can help increase adherence (browse Apple’s App store if you’d like).  However, to my knowledge, trying to make the unpleasant task of taking a medication into a pleasant one has not yet been explored.

Dan Ariely, a professor of psychology and behavioral economics at Duke, had a similar realization during his treatment for hepatitis C.  At that time, treatment required interferon, an injectable medication given three times weekly, with the unfortunate side effects of fever, nausea, headaches, and vomiting.  He made his treatment more manageable by treating himself to a movie after every injection.  This technique “helped [him] associate the injection more closely with the fun of watching a movie instead of the unpleasantness of the side effects.”  He tells this story, and many more, in his wonderfully interesting book The Upside of Irrationality.  You can read an excerpt from the book in his blog.  

Humans, Ariely argues, are not rational beings.  Even though it is in our best long-term interest to floss daily, take our medications, eat healthy, and exercise, many of us forego these activities due to the short-term discomfort they sometimes cause.

My (and Ariely’s) solution?  Make sure you link the painful but good activity with something you really enjoy (flossing while watching a TED video, medications with a movie marathon, exercise with great music, etc).  That way, you may actually start looking forward to these activities.  And, you’ll probably live longer too!


What tricks or “hacks” help you complete unpleasant tasks?