What did you expect?

By March 2, 2009Uncategorized

There was an interesting video piece in today's Predictably Irrational blog about the influence of expectations. This topic speaks particularly acutely, I think, to adherence. I won't rehash the whole piece here, but suffice to say that expectations matter.


We tend to think of adherence as the result of the creation of an ongoing relationship with the patient. This is definitely true, but it's also incomplete, because the relationship begins before the relationship begins, so to speak. What people expect has a profound impact on their experiences of what they actually get. Sometimes this expectation actually affects the clinical outcome itself. After all, healthcare expectations are closely tied to the patient's own sense of self, their health, and sometimes, profound changes in their lives.

A great deal of anyone's perception of anything is a function of expectations. They don't compare the experience with their pre-experience state; they compare it with their expectations. The business version of this is "underpromise and overdeliver." And the actual providers of healthcare — physicians, dentists, nurses — are well aware of the role of expectations, and use it all the time. Consider:

  • The placebo effect.
  • The dentist who, before giving you an injection, tells you that it's going to pinch a little bit. It actually hurts, and in a way that's nothing like pinch, but your expectation makes it quite manageable.
  • The physician whose wall is covered with diplomas, certificates, and other symbols that prime you to respect and listen to him.

The imagination, which is what expectations are based on, is an extraordinarily powerful thing. Based on a description, people will envision themselves going through some experience in the future. This concept, really, is the foundation of almost all sales, and of a great deal of marketing. You drink this beer, you get to date the beautiful girl. And so on.

Given this, what kind of messaging are you conveying to your patients prior to their experience of the drug? What are you conditioning them to expect? Are their additional things you're conditioning them to experience during the course of treatment? It's really a kind of game of conceptual follow-the-leader. The more consistently you can create expectations in advance of any kind of patient experience, the more you can manage the perception of the experience, the definition of what it means, and in some respects, the eventual outcome.

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