The Annual Physical I *Still* Haven’t Had

By Cinnamon Janzer (ideas42)

People avoid going to the doctor. I’m cold, hard evidence of that unfortunate fact: it’s now been more than six months since I moved to NYC, and I still haven’t had the annual check-up that’s now five months overdue. It’s not that I can’t (I have excellent health insurance), or that I don’t think it’s important, or that I don’t fully intend to go very soon. The problem, I’ve realized after extensive marveling at my own shortcomings, is that the entire process of making and keeping an appointment is rife with behavioral bottlenecks, each one an opportunity to derail my original intention.

The good news is that I’m apparently not alone. After lamenting my inability to handle the minutiae of adulthood to a friend, I was introduced to ZocDoc, the Uber of healthcare apps—more than 700 employees, 5 million users, and funding upwards of $100M. The company’s mission is to “fix broken systems that get in the way of good care,” based on the idea that if we can “buy everything from soap to airfare with the swipe of a phone, why [is] healthcare so different?” I was eager to see if this app could really combat the behavioral bottlenecks standing between the doctor and me, so I tried it out.

Barrier 1: Finding a Doctor

What looks like one choice—what doctor do I want to go to?—is actually a whole bunch of little choices: Who takes my insurance? Whose office is close to work or home? Who’s accepting new patients? Do I want a male or female doctor? Finding answers to these questions is rarely easy and often requires a Herculean amount of effort in the form of phone calls, cross-referencing, and website deciphering. What should be a five-minute task becomes hours of effort that is easy to put off… indefinitely.

When we’re overloaded with choices or intimidated by the amount of perceived work ahead, many of us (consciously or unconsciously) simply avoid the task altogether. ZocDoc attempts to fix this by aggregating relevant information in one place and allowing users to search based on criteria like types of insurance accepted, patient rating, and location. Add all the filters you need, and rather than sorting through an entire universe of doctors, you may have 5 or 10 to compare side by side.

Success. Doctor identified.

Barrier 2: Scheduling an Appointment

Again, hassles abound: you have to call during certain business hours, usually when you’re at work yourself, and often have to wait through annoying periods of being placed on hold. Once you finally get connected with a real person, it’s not uncommon to learn that the next available appointment is several months in the future. Because you and the receptionist can’t see each other’s schedules, an extended back-and-forth negotiation is often required before you hit on a time that works. Again, what should be a simple task is actually fraught with tiny hassles, little opportunities for you to simply decide to do it “later.”

ZocDoc seeks to solve this by adding a one-click scheduling option for each doctor in its library. While you’re browsing for doctors (and your intention to get that check-up is strongest), you can click your way to an appointment, with no need to remember to call on your lunch break or subject yourself to the irritating jazz intended to soothe you while you’re on hold.

Great. Appointment scheduled.

Barrier 3: Remembering to Go

You may be sensing a trend here: the hassles aren’t over yet. You still have to actually get yourself to the doctor’s office. This means both remembering the date and time of the appointment and extricating yourself from competing responsibilities at work and home.

ZocDoc solves the prospective memory problem by sending you some well-timed reminders that your appointment is coming up (via text and/or email, depending on your preference). The appointment stays salient in your mind, decreasing the chance that you’ll forget about leaving work early enough to get there on time.

But, alas, it doesn’t work nearly as well as a commitment device. I got handy email reminders before my appointment, but they also included a one-click option to reschedule or cancel with no penalty. And I ended up doing that. A lot. With no excuses to be fabricated and no receptionists to judge me, I had a free pass to change my mind if things like work (read: happy hour) got in the way.

It appears that ZocDoc actually removed too many hassles. When the social accountability and sense of urgency around the appointment were removed, it became no big deal for me to put the appointment off, ad infinitum, resulting in me still not actually getting to the doctor.

This brings me to a larger point: behaviorally-informed design is not just about making things easier. Sometimes hassles serve an important purpose–the trick is to recognize the distinction between “good” and “bad” hassles. If the goal is to get more people to the doctor, appointments should be easy to make and harder (though not impossible) to get out of. If canceling an appointment is as easy as hitting the Snooze button, things like the siren call of Netflix, an impromptu beach day with friends, or even that pile of paperwork become more than enough to derail you.

As for me, I’m still in search of that perfect product, but I’ve got an appointment for Thursday afternoon—and I fully intend to be there.

Image credit - jasleen_kaur