Experience as Medicine

“The Point” Episode 4: Experience as Medicine

Chris Ledford, Operating Partner and VP of Strategy, The Grovery: Welcome to this episode of “The Point,” where we discuss everything customer experience. I'm Chris Ledford, your host today, and I'm really excited to have the founder of Rx4CX here.

Rich Schwartz, founder, Rx4CX: Great to see you. Great to be here.

Chris: The behavioral science and economics of illness. Talk about it at a high level, so we understand what you mean when you say it.

Rich: It's based on how humans decide and behave, and a lot of that behavior comes from our mindset and what we believe. I shared a video with you from one of my favorite researchers, Dr. Alia Crum at Stanford, and the work she has done on mindset. I saw her give a talk at TEDMED in about 2016 that completely flipped how I was thinking about things, because she talked about the treatment effect.

One of the pieces of research she worked on around mindset was with hotel maids. They took about 88 hotel maids and told half of them that the work they do is exercise: changing sheets, vacuuming, getting down on their knees, cleaning the bathrooms, dusting the curtains, pushing their carts around, and folding towels. It's the equivalent of going to a gym. They told half of them that, and they showed them the data. They didn't tell the other half. Then everyone went about their work, and the researchers measured their blood pressure, their cholesterol, their emotional well-being, and their weight.

And guess what? All of the metrics you would want to come down or go up did for the group that believed it was exercise. They lost weight. Their cholesterol was lower. Their blood pressure was lower. They felt great about what they were doing. They were given purpose. The behavioral science on mindset and how people decide should not be an aside.

Chris: So in the behavioral science of decision making within this critical moment, there's a price to pay. Emotionally. I would even say, based on my understanding of everything you've shared, that emotional cost of being sick gets in the way of me getting better. Talk about that.

Rich: There was research, and they called it the Breaking Bad study. In the Breaking Bad study, they looked at people who had been diagnosed with cancer and survived. A few years down the road, their propensity to commit crime went up.

Wow. Why? I don't think the study came out with a full understanding of why. Was it anger? Was it accepting my own mortality and deciding I'm going to do what I want?

For me, I had kind of a triple thing. I was diagnosed with a condition nicknamed the Widowmaker, which is really cool to have. Then, about a year later, I got the cancer diagnosis.

But in that, what I found is what changed me and led me to create this notion of experience as medicine, the clinical value of experiences. It came from what I went through.

I had one physician where we had an argument in the hallway of this cardiologist's office that brought people from around the corner. He was arrogant, and he wasn't listening to me. I kept trying to communicate something to him, and he kept telling me to be quiet and listen.

Chris: Did they have to call security on you?

Rich: No. But another physician came out, a young guy who looked like a brand-new physician. He said, "Come with me," and then, "Hey, what's going on?" We sat down, and I explained that the other physician had questioned whether the data from my Apple Watch was valid. He said, "Well, let me see it." We looked at it, and he said, "I want to do a test." I said, "Okay." He said, "I want to do a test with our really expensive machine against the results on your watch." And I said, "Okay, if it's the same, I'm not paying for the test." He said, "Deal."

So we did the test, and that guy ended up operating on me three weeks later for the very thing I thought was wrong. And the cool thing was, his name was Dr. Angel. It's pretty poetic.

You have to be able to question your care team. When I got the melanoma diagnosis, it was because my primary care physician said, "I don't like that. I don't like the looks of that. I want you to go, and I want you to go this week. You're not going to wait. You're going to go this week." I said, "Well, you sound worried about it." She said, "I am worried about it." And she gave me the biggest hug. That was medicine.

That relationship, Dr. Angel, my primary care doctor, the incredible staff, and the people who supported me throughout were part of my healing. They were part of my medicine. That's why the experiences we have carry clinical implications.

Chris: That goes back to the creation of the feeling and the power of the feeling. It's also why I think paying special attention to caregivers is so important. Who is more medicine in the situation than that trusted caregiver?

Rich: I was working on a project with a big pharma company, and I had to do a data readout to their executives on some of the things we were learning about the experience. I'm a bit of a data whisperer, so I noticed an anomaly inside the data, and I wanted to understand why. Patients seemed to have really great feedback on everything we were doing. Clinicians seemed to have really great feedback. But there was one group that didn't, and it was caregivers.

I asked why that was. The caregivers were basically saying, "You've taken the patient content and kind of put 'caregiver' in it. I have different needs. I have different things going on in the context of the person I care for and love having this condition. I need your support there. They go to sleep at night, and I'm a wreck. I'm not sleeping. I'm scared for them." And in some cases, caregivers are doing all the driving in serious and rare disease. At some juncture, we have to nurture those people.

Chris: I've heard you say there's a cost to be paid in the decrease in cognitive bandwidth because of illness, and how that, in turn, affects the entire experience. Dig into that a little bit.

Rich: It's your cognitive load. When you get a diagnosis and you hear "this is psoriasis" or "this is diabetes" or "this is cancer" or "this is heart disease," whatever it is, it's deeply personal. And nobody trained us how to do it. Nobody taught you how to be a patient. Your mind goes in a thousand different directions, and you start reading and over-reading and thinking and asking. We have this beautiful thing called the internet, and now we have these beautiful things called large language models, and you can go down a rabbit hole really quickly. I spent 10 years at WebMD, so I know a lot about what people do and how they behave.

We have to reduce the cognitive load for people. Certain types of people are going to want to go down that rabbit hole and need to go down that rabbit hole. And then there's the cognitive load, not only clinically and emotionally, but logistically. Are we making this really hard for people, or is somebody else making it hard for people? And what can we do about it?

Rich: There's a group called the Physicians Foundation. For about eight years in a row, they asked physicians what the most satisfying part of being a doctor is. The choices were collegial collaboration, scientific curiosity, money, prestige, and relationship with patients. Year after year after year after year, it was the relationships they had with patients that were the most satisfying part of their careers. And now we have somebody who's sick going to somebody whose aspirations the whole system conspires against.

If we're going to do anything as a brand, as a pharma brand, we should pull back and ask what we can do to support the relationship when those two people collide. Nothing is going to happen until they collide, and what happens in that moment dictates what happens next.

In Dr. Crum's work, she even shows what happens when a physician enters the equation and says to the patient, "I'm going to try this. I'm going to put you on this drug. I've had great experience with it, and I'm in this with you." Versus, "Hey, on your way out, I've written a prescription. You can pick it up here. Any questions, give us a call." Which patient do you think does better? The first one, naturally.

Let's create that. Let's create a situation where the physician wants to do that and is able to do that. We understand the constraints they're under, we understand the constraints the patient is under, and we reduce the cognitive load for everybody. That's just being helpful. Chris, it's just being more helpful. It's just being more human.

Chris: Is there any work on the true cost? It seems like that 15 minutes is a matter of economics. How do we point out that creating a good experience is also good economics? Or how can we document that and get the evidence to say, "Create the experience, and you will have a more financially sound system"?

Rich: Compassion is empathy's more athletic cousin. Empathy is "I felt something." Compassion is "I did something." Compassionomics outlines all of it for you. In the British Medical Journal, there's a compendium, a list of studies that demonstrate that when people feel good, they do good.

Chris: If that evidence is there, why do you think it's not more embraced?

Rich: It's harder to measure. So create different measures. Measure how helpful you're perceived to be. Measure reciprocity. Measure whether that experience reduced the cognitive load for people. We still have to measure NBRx, Rx, and TRx. We have to measure all of that. But the person's path there wasn't linear.

Chris: When we look at the design of the system, it feels to me like this entire concept of diminished cognitive bandwidth, which keeps me from getting better, from making better decisions, and from feeling the way I want to feel, is being overlooked. As a final note, what is one thing someone could do to improve that?

Rich: Look at the lived journey that people are having, the actual lived journey of that person. Don't create a journey where you're the pot of gold at the end of it. That's a fairy tale, and it's not always achievable. Look at the journey where what's at the end of it is that this person is either better, or feels better getting better.

Chris: I want to thank everyone for joining us today, and especially you, Rich, for coming in. We really appreciate it. We will see you next time on “The Point.”