Members from Mars and Their Cars

By Laurie Gelb, December 10, 2012

You wake up one morning and decide gasoline costs are just too high. You want to begin filling your car's gas tank with water, which is, of course, much cheaper. You call your mechanic to find out if this is a good idea. He sadly tells you that it will not work. Chastened, you text your broker to invest in some alternative energy stocks.

What is unlikely about this scenario? Well, first and foremost, you have already internalized the fact that water will not run your car. You don't blame car manufacturers or your mechanic or even the oil producers for this. You don't call them biased and part of the IMF conspiracy. You recognize that what they all say (and consistently) is a fact and you proceed accordingly. In part, this is because you have abstracted at least of the chemical differences between gasoline and water, which will also help you recognize important safety hazards  like not throwing water on certain types of fires.

How much do your members and patients know about the vehicle they occupy 24/7-- their own body?  How much do you know about what they know? How many hopeful or destructive assumptions are they making, seeking information about, and/or simply acting on with no relevant evidence at all? Apart from transactional correspondence like enrollment and EOBs, the common thread within all your health communication can perhaps be described as attempts to drive behavior and choices that safeguard your customers' vehicles, if you will.

Unfortunately, health and disease management are often perceived in terms of being a cheerleader for fresh fruit snacks, when instead patients could most benefit from the calm, factual mechanic who leverages his customer's existing knowledge to improve understanding of the mechanisms that run your car. If you in a moment of extreme forgetfulness or frustration did ever call your mechanic and ask, "Why can't I use water in my gas tank?" he probably wouldn't begin his answer with, "For centuries, cars have been designed to utilize gasoline" or "Are you insane?" He'd probably say, "Carl, I realize it's tempting [empathy] but not only won't it work, it'll destroy your car's engine [clarifying stakes]. If you want to save money, have you thought about buying a car with better mileage or a hybrid? [positive alternatives] What are you driving now, that old Buick? [baselining]" And so on.

The bottom line: any mechanic or service provider...until we get to health care, education and a few other problem areas... that receives frequent customer calls and has a successful practice has likely learned how to communicate reasonably effectively while still driving repeat business and trust. And the auto/energy industries as a whole have largely succeeded in disseminating/reinforcing certain key bits of information on a pre-need basis. So the least sophisticated teenager knows not to pour water into a gasoline-powered engine, complete klutzes like me can put air in a tire or change a light bulb and life goes on.

Yet, with the stakes higher in medicine, people don't always dose analgesics correctly. Why? In part, we have failed to remain calm, neutral information providers in the face of human fear, anger, denial, confusion and vulnerability. Health care is no more the place for cheerleading or fear-mongering than the automotive world. Auto dealers do not post signs saying "Warning! Buying the wrong car could result in a fatal accident!"  even though technically it is true that car integrity/stability/maneuverability varies. Instead, they build a case across media channels, back it up with evidence and build its salience via brands. Which do you think is safer, a Volvo or a Lamborghini?

When a migraine or cerebrovascular event strikes, we want the patient to be responsible with OTC preps and seek care if/as needed. These are both pre-need education stories, but they only get internalized to the extent that they are believable. When they are dogmatic, on the order of "Are you insane?", contradictory, jargon-laden and/or confusing (sound familiar?), they cannot be internalized as early and often fail to drive outcomes.

So before you approve any more educational copy this week, you might ask your mechanic if it makes sense.