It usually goes something like this:

• Patient goes to see doctor for an ailment
• Doctor assesses patient
• Doctor writes patient a prescription
• Patient thanks doctor and leaves, prescription in hand
• Patient decides not to fill the prescription.

From then on, the doctor and patient are operating under conflicting assumptions—a great plot for a 70s sitcom, but bad news for better medical care.

Recent research looked at primary nonadherence, that is, patients failing to fill an initial prescription. Rates of nonadherence were highest in metabolic diseases such as diabetes (31%), hypertension (28.4%) and high cholesterol (28.2%).

If so many people are failing to fill their scripts, but the doctor assumes that they are taking the medication as prescribed, how can treatment progress effectively?

Doctors are only as good as the information they have.

Given the high rate of primary nonadherence, doctors should make the following direct question a standard part of follow up visits, “Did you fill the prescription for Drug X that I gave you?” People are less likely to lie in the face of a direct question.

Obviously that one question won’t solve the communication disconnects that plague doctors and patients, but it’s a start.

So don’t lie to your doctors.  Trust me, they’d rather hear the ugly truth.

It’s no surprise that women are often the target when it comes to healthcare and pharmaceutical marketing. They are often the gatekeepers to medical care and information for their families. They are more likely than men to search for online health information, search on someone else’s behalf, and seek online support.  

Being a part of communities is the fabric of women. Perfect example – in today’s “wired” world women are drawn towards online applications that allow them to connect with others and share information vs. men whose online activities tend to be more transactional in nature.

As marketers, that means that women are an easy target, right? After all, it’s not difficult to find where to connect with women, especially online.  But the key is figuring out how to engage them. 

The mistake that many marketers make is speaking broadly to women, assuming that based on a few demographic variables that they are targeting key interests and pain points in women.

 Yes, as women, we do often have a lot in common.  As a thirty something woman, I can easily find another thirty something woman who struggles with making time for herself, consistently disciplining children and figuring out what to fix for dinner.

But when it comes to health and illness, as a marketer, there is much more I need to understand about my audience in order to change their behavior – it’s the “why” that is so important. It’s those behavioral buttons that we can leverage to have greater relevance and impact.

We recently conducted some research in women diagnosed with cancer.  What we found is that even women experiencing the same type of treatment, in the same stage of cancer – their experience of living with cancer and psychologically, how they cope, is dynamic and individual.  Some women are very active in how they cope. They are forward looking, optimistic, wanting to know pragmatically what’s next. They want to reach out and help others. On the other hand, other women are passive. They follow physician advice, want to be cared for and they are constantly looking back – asking “why me?” No doubt that different marketing strategies and messages would be required to have a powerful connection to these different mindsets.

We can’t address every variation in our audience. But with an insightful approach, we can prioritize and focus on those core behavioral drivers that lead us to more meaningful, authentic conversations and greater trust.

With reports of unintended acceleration in several models, including hybrids racing at high speeds (but cleanly!) down busy interstates, Toyota and its products are being blamed for not addressing safety concerns adequately. Of course they aren’t the only ones taking the blame – the NHTSA is also under fire for not investigating more thoroughly. Lots of “they didn’t do this” and “they said they fixed it” being thrown around…

Yet hardly anyone is talking about the drivers’ role.

This reminds me a lot of how we often approach our own health. We, as patients and consumers, rely on “they” to do all of the hard work. Only in this case, “they” applies to the pharma manufacturers, the FDA and health care practitioners. When there are problems with specific medicines, or even when our health isn’t as good as it should be, “they” are always around to take the blame.

No one would argue that there aren’t some bad players out there, but it’s time that “we” started to take on more responsibility with healthcare. The information we need is there – pharma companies spend millions every year trying to educate patients and physicians.

Like a car, the recommendations and medications that doctors provide to us are just a tool, a conveyance, to get from a starting point to a goal. We all need to do a better job of how we handle it before things really get out of control.

I was talking to a colleague the other day about an unexpected finding from a study we conducted on people with diabetes, hypertension or high blood pressure. We were surprised to find that those who make the most active health decisions aren’t exactly the best patients.

In fact, “active” patients are more likely to stop taking their medication on their own accord, and they are much less likely to have regular medical check-ups. And when it comes to successfully managing their condition, they are better off than “passive” patients but worse off than “collaborative” patients.

Okay, so I am confused. Isn’t an informed and engaged patient a better patient? Being a nurse and a health educator, I can relate numerous examples of how a patient’s active involvement in their health (or lack thereof) had an immediate and profound impact.

And if personal experience isn’t proof enough, there is a ton of research that clearly shows positive outcomes in patients that take an active role. I could rattle off dozens of terms that have showered the health and behavioral landscape over the past 10 years – shared decision making,  consumerism of healthcare, epatients, consumer directed care…there are even organizations whose sole mission is to promote active involvement.

But then we discovered a critical piece of the puzzle – trust. The most active group of patients had the lowest trust in their healthcare provider and were the least likely to view them as an expert.

Have these patients become active in their healthcare to the point of self-reliance? Perhaps they feel let down by the healthcare system, perhaps they are misinformed, or perhaps they are fearful and afraid to let go of the reins?

So what? As health educators, we encourage and empower patients with information. But clearly that is not enough. We need to look for ways that we can engender trust and facilitate an empowered and collaborative approach to the patient-healthcare provider relationship. And as marketers, we can’t make assumptions that patients who are “active” are where we want them to be.

Knowledge alone is not enough. If it was, no one would smoke, be overweight or eat potato chips.

We’re fat. Fatter than we’ve ever been. America’s future is one in which obesity kills more people than smoking and alcohol.

Everyone’s talking about it. The First Lady is taking on childhood obesity. The Wall Street Journal is explaining how its roots are in our genes. Obesity’s links to processed foods,  portion creep and lack of sleep are being debated.

We’re working longer hours and commuting more. Our jobs have become more sedentary and we can’t find time to exercise. Not to mention the fact that healthy foods are expensive and unhealthy foods are cheap.

So we’ve got some disadvantages. But what about people who have lots of advantages? What about people like Oprah?  She can afford personal trainers and chefs. She has every financial advantage, yet she still struggles with her weight.

It’s tempting to think, “If only I had a personal chef, if only I had a personal trainer, if only I didn’t have to work such long hours.” But when you remove all of the “if onlys” that money can buy, success isn’t inevitable.

Why is it so hard for Oprah? For the same reason it’s so hard for the rest of us. Sometimes we don’t know any better. Sometimes we’re duped by clever marketers (remember Snackwells?)  But most of the time, even though we know better, we still make bad choices. Why?

Knowledge alone is not enough. Decision making is rooted in complex psychology.  It’s a complicated interplay between information, motivation, skills and confidence. Without all four, real behavior change is tough to come by.

Like everyone else, I make bad food and exercise choices. It’s ironic, though, because I work with smart people who make a living as health-inducing puppetmasters. I guess it’s a case of the shoemaker’s children.  Maybe I should walk down the hall and see how they can help me modify some of my unhealthy behaviors.

I’m going to do just that.  As soon as I finish these chips.