Years ago, when I was still practicing, a medical representative came into my room on a morning when patients filled every corner of the waiting area. He was quick, polite and full of energy, and he made his case well. As soon as he left, the details of what he had said vanished. Nothing in his message was wrong. I had nowhere left to put it.
Practicing medicine put me in front of problems I could either shrug at and move past, or go looking into. I decided to look, and the further I went, the more the answer turned out to be something small and well placed rather than something large and loud. This book is the culmination of that search: what I saw as a physician, what I learned as a marketer, and what we have built since.
We keep misdiagnosing the failure
When a message doesn't land, we assume we aimed it badly. So we buy better data, tighten the segments, add a channel, raise the frequency. Underneath all of it sits an assumption: the physician would have taken this in, if only it had been the right message delivered the right way.
Sometimes that's true. Often it isn't. A primary care physician now receives around forty-nine messages a day through the EHR alone. Doctors spend close to six hours of a working day inside EHRs, e-prescribing tools and telehealth platforms. Burnout among American physicians has run as high as sixty-three percent, and managing the inbox is among the largest contributors to it.
That is not an audience with an attention problem. That is an audience with no room left. Precision of aim does not create room, because a perfectly targeted message still arrives into a full day. Precision of timing does, and it is a different discipline and a harder one.
A physician is not a typical consumer
Healthcare marketing borrowed its instruments from consumer advertising, and those instruments are built to manufacture familiarity through repetition. Repetition is the first thing a saturated mind discards.
The decision they are built to influence is not the decision a doctor is making. A physician choosing a treatment is not expressing a preference or a brand loyalty. She is weighing clinical evidence, guidelines, ethical considerations and the specific patient in front of her, inside whatever minutes the day has left. Marketing designed to build preference is aiming at a decision that is not being made.
What works is smaller than what we are doing
The alternative is not a louder version of the same thing. It is a well-timed, minor intervention that makes the better decision easier while leaving every other option open. That last condition is not decoration. Remove it and you are no longer nudging.
I learned this before I had the vocabulary for it. In October 2016, over dinner in Delhi, my friend and colleague Dr. Daniel Carucci broke off mid-sentence to ask about the black thread tied around my eight-month-old son's arm. I told him it was a sacred thread, that mothers tie it on their children to ward off the evil eye and keep them safe. Then I heard myself say: isn't that what immunization does too? Five months later, with the teams at McCann Health, UNICEF and Afghanistan's Ministry of Public Health, the Immunity Charm went out in Kabul — the same thread Afghan mothers already trusted, with a colored bead threaded in for every vaccine a child received.
Nothing about it argued with anyone. It worked with a belief those mothers already held rather than against it, and it made a child's protection into something you could see, in a form that required no reading or writing from a parent. Health workers took it up as the immunization record they had never had, in a country where displacement and violence routinely destroy paper ones. Mothers began asking for bracelets for their other children.
I wrote this book for the people deciding what our industry builds next. Ten chapters on how doctors actually decide, what behavioral science has understood for decades that healthcare marketing has been slow to apply, and what nudges look like when they live inside clinical workflows rather than on top of a media plan. Cass Sunstein generously allowed me to include his essay "Nudging: A Very Short Guide" as an appendix, so the theory sits alongside the practice.
What we decide AI is for
Our industry is about to settle a question, largely by default. The easy answer is that AI helps us make more, faster and cheaper. I think that is the wrong answer, and not because volume is somehow immoral. It is because volume is the thing that stopped working.
What these systems are genuinely good at is context. Knowing that this physician has a patient for whom this matters, that today is the day it matters, and that three weeks from now, when the labs come back, is the moment to say something useful.
And the useful moments do not stop when the prescription is written. That is where our industry has traditionally stopped paying attention, and it is where most of the value quietly leaks away. Nearly seven in ten patients walk away from a medicine at the counter once their share of the cost passes around $250. The assistance programs built to prevent precisely that go unused more than ninety percent of the time, largely because neither the patient nor the physician knew they existed at the moment it would have mattered. That is not a persuasion problem. It is a timing problem, which is another way of saying it is a nudge waiting to be built.
This stretch — from fill to refill — is the part of the journey I find most interesting, and it is where we have put our energy at Doceree: co-pay eligibility and patient support delivered inside the EHR and e-prescribing workflow at the moment the script is written, rather than in a brochure someone reads later. Used this way, marketing stops feeling like an interruption and becomes part of the physician's workflow.
It is also why I think the argument matters now rather than eventually. For most of my career, the cost of producing content was itself a limit on how much of it we could send. That limit is gone. What replaces it is a choice, and the tools being built this year will make it for the next decade.
The Next Marketing: From Molecule to Mindset is out now. It ends on a question I would rather put to you than answer myself: what's your nudge? The next chapter of healthcare will not be written by any one company, and I would like to hear what you are building.
— Harshit Jain, MD Founder & Global CEO, Doceree