I remember very little of what I actually learnt during my A-levels. But one of the few nuggets to survive is the idea of utility.
It all started one stifling, autumnal afternoon. A class of 20 or so first-year students crowd around the desks, in one of those port-a-cabin turned classrooms that still seem to be in service. Mr Hooley (ex-Army, crew-cut, not a lot of time for fools) arrives and starts preparing the lesson. It was a while ago now, so out come the acetates and on goes the overhead projector. The topic for the day was the Law of Diminishing Marginal Utility.
Stay with me.
Utility, to economists, is a measure of the satisfaction we get from consuming a unit of something. It could be a song, a snack or a good book. The central idea of the Law of Diminishing Marginal Utility is this: we get a decreasing amount of satisfaction for each additional unit of the thing that we consume.
The genius of Mr Hooley
Here lies the genius of Mr Hooley. He found a way of making the idea of diminishing marginal utility come alive to a bunch of not-yet-legally-allowed-to-drink-but-doing-it-anyway students. Something so simple that it’s stuck with me for over 20 years. It goes like this.
On a hot summer’s day.
The first pint is amazing.
The second pint is good, but it’s not quite as good as the first one.
Given constant exposure, it’s human nature to feel diminishing returns from pretty much everything. This is why forums on social media have become so important for patients and those interested in making their lives better. They do so much more than provide (mis)information, they help counter the law of diminishing returns.
Let me explain.
What we say to ourselves
Our health plays a leading role in the story of our lives. It’s the pages on which everything else is written.
We all have something called a dominant self-narrative. It’s a bit like all the voices in your head coming together until one comes out on top. It’s the part of you which holds the beliefs of who you are and who you think you’ll be. I’m a good person. I’m a careful driver. I’m a loving father. One day I’ll have a six-pack (there’s still time…!) This narrative develops alongside our lives, slowly. It’s a bit like a psychological North Star, guiding our actions along a path to the person we want to be.
All this ticks along nicely, until life gets in the way. In the same way that most people think they’re better than average drivers, we don’t expect to become ill. No one dreams of not being able to have children. Cancer happens to other people. We’re not going to get diabetes. Unfortunately, these things happen, and when they do, we have to come to terms with their physical and emotional impact. We also have to, eventually, accept that our dominant self-narrative is out of date.
This brings us back to the problem of the second pint. No matter how empathetic you are, it’s natural to have a less intense reaction to a recurring event. This includes feeling sympathy and having time for those who are unwell. We’ve seen it in many illnesses and across many countries. Patients with chronic conditions often feel that those around them don’t really get it. The intense sympathy they feel on diagnosis tends to diminish as time goes by. However, the symptoms don’t.
So we have a situation where patients with chronic illnesses feel the effects in the same way, in an increasingly less compassionate world. There’s a sympathy gap. What do they do? They turn to people like them, people with the same conditions, people who do get it. Forums make physical proximity meaningless, prior relationships irrelevant, cultural barriers insignificant. Rather, the sympathy gap is filled by the understanding and empathy that comes from people with shared experiences. Forums are the connective force that brings these people together.
By connecting people in the same situation, forums serve three vital purposes:
- They provide information: forum threads are brimming with requests for information. People ask about the condition, the treatment, the symptoms, the costs, the pain, the impact on their life. Which, if you think about it, is a bit odd. Healthcare organisations spend huge amounts to educate and inform – but there’s something about peer information that cuts through this, it feels more relevant, more tailored, more sensitive and, importantly more independent. We have a strong need to validate what we’re unsure about.
- They provide immediate emotional support: they’re somewhere to go when things turn rough. It’s easy to explain to someone else what a Rheumatoid Arthritic flare-up feels like, if they have them too. And that’s the point, you don’t need to explain it. They get it. They know how you feel and the support you need.
- They help you re-write the life story you want to lead: coming to terms with a life-changing illness is easier said than done. It takes ages to unpick the version of you, you always thought you’d be and come to terms with the person you’ve become. We’ve seen many examples of long-term, supportive relationships on forums, where people help each other find new purpose and meaning in life.
Responding to a market failure
That forums have so quickly become a major force in healthcare, speaks volumes. It’s a story of market failure; where organisations have failed to provide everything that patients need.
For too long it’s been OK to misunderstand or overlook forums. It’s been amusing to see them as the ‘fake news’ of medicine. But this view is simplistic, distracting and out-of-date.
The reality is that they’re providing something that no-one else is, they’re meeting this market need and are attracting patients in their droves.
This means that the bar for attracting and engaging with patients has been raised. Traditional spheres of influence have been hijacked and brands will have to fight to win them back.
For patients the current choice is stark. When you’re struggling with a new illness, how do you spend your time? Wading through a dry, information-heavy web page, or talking with someone in the same situation as you?
If you want to influence patient choice and behaviour, you need to understand how the dynamics of influence and support have changed. Those that do, will find themselves better equipped to connect, engage and support the needs of patients and those who care for them.
Jeremy is the founder and MD of Listen + Learn Research, an insights agency that uses social data to help brands + their agencies find new opportunities for growth.