Friday, December 23, 2011
Patients as Consumers: The Milkshake Mistake
I keep running up against the tension over characterizing patients as consumers. Although Nobelist Paul Krugman explicitly said "Patients are not Consumers" in a NYTimes column this past April, other business and economics notables, such as Clayton Christensen, encourage innovation in the world of medical care delivery modeled on consumer service industries.
Personally, when musing casually about patients as consumers, I've found myself alternately rebuffed (for blaspheming the sacred doctor-patient relationship) and encouraged (for probing methods of caring for patients' true needs) by my medical seniors. I've since learned to test the sensitivities of my audience before even hinting at comparing patients and consumers.
Here, rather than attempt to put the issue to rest, I simply want to present one example where viewing patients as consumers stands not only to improve their care, but to actually deepen the humanist goals of those who are otherwise afraid of commoditizing a covenant.
The Milkshake Mistake
Clayton Christensen and others have used a case study of McDonalds to illustrate the value of stepping inside the consumer's shoes. Specifically, how do you see the value of your service, not as what you think the consumer should desire, but as what they truly seek.
The example, adopted from an article in the Harvard Business Review, has been termed the Milkshake Mistake. Briefly, McDonalds was conducting product research on how to sell more milkshakes. Researcher Gerald Berstell was surprised to discover that most shakes were purchased by early morning commuters who used the shakes as a one-handed tasty breakfast that was easy to eat and kept them awake in the car. After Berstell had examined the milkshake from the consumers' perspective, McDonalds could abandon their assumptions about what consumers wanted from their milkshakes, and instead tailor milkshake delivery more precisely to their consumers true needs.
As Christensen details in The Innovator's Prescription, this speaks powerfully to health care. Providers, with their years of training and advanced expertise, may have assumptions about the desires of their patients that are not consistent with what patients truly seek from their doctors. Although this kind of market research draws directly from the business world, and baldly views patients as consumers of a service, it nonetheless stands to improve the doctor-patient relationship by clearly identifying motivations and needs.
A candidate milkshake mistake in medicine is the negative views about one of my favorite medical apps, Skin of Mine, which I've written about here. Physicians to whom I've shown the app often reject it, saying "patients want their doctor, not a phone," or "how can they trust it?" The potential milkshake mistake in these rejections is that many patients prioritize not missing work to get their skin evaluated above a face-to-face interaction with a doctor.
The crucial point for those, like Krugman, who rail against commodifying the doctor-patient relationship is this: until the market research is completed, we're just guessing whether "patients want their doctor," or whether they simply prefer convenience. Until we consider that patients are like consumers, we may in fact be cheapening the doctor-patient relationship by relegating how we optimize care to our own guesswork.