Want Fries With That?

By November 28, 2007Uncategorized

There was an absolutely fascinating variation on relationship marketing written up in yesterday’s Wall Street Journal Health Blog. The post, which was written by Shirley S. Wang, described a commentary in JAMA that suggested making the healthier choice the default option for patients in some situations rather than one choice among many. For example, automatically schedule a follow-up appointment or a colonoscopy rather than reminding the patient to do it. If they want to, they can change or reschedule it, but if they do nothing, the healthier option happens.

On one level, this is the most obvious thing in the world. On another, though, it’s a wonderful example of the most basic principle of relationship marketing — taking into account how the actual patient with the actual condition actually behaves, and then accomodating that, rather than vice-versa.

IFrench_friesf you’re designing a car, you build in cupholders, because people drink coffee while they drive. If  you’re developing a voice-activated telephone response system, you base the options on what people tend to ask. If you’re Princess Diana, and you’re getting married to the Prince of Wales, and you have a thirty-foot train behind your wedding gown, you have a couple of bridesmaids on hand to help you with it. All of these are Blinding Flashes of the Obvious.

And in healthcare, you pay attention to how patients — your customers — behave, and you use that information. Getting patients to stay on their medication regimen takes a lot more than having some doctor tell them to. Patients are human, and therefore influenced by all kinds of factors, many of which are irrational. This is what we do for a living here at TrueHealth. We build programs around what patients actually do, not what they should do. It appears that behavioral economics supports this.

One legendary example is the now-ubiquitous question asked at thousands of fast-food counters every day: "Would you like fries with that?" Because people naturally, automatically, unthinkingly tend to respond with a "Yes" or "Sure", the simple act of asking that question has resulted in billions of dollars in extra revenue for McDonald’s, Wendy’s, Burger King et. al. Whoever thought of that should have been given an island in the Carribean.

Another one, as noted by the JAMA commentators, is people’s inherent bias towards inaction. If the options are "do nothing" vs. "do something" the former has a distinct edge. If you use this fact, and structure things so that "do nothing" results in a healthier outcome, everyone wins.