The Myth of the Individual Decision-Maker in Healthcare

Over the years, I’ve written quite a bit about my relationship with fitness -- specifically my long-standing habit of riding at SoulCycle on a pretty much daily basis. For the past decade, SoulCycle has been a constant for me. A place where I can walk in, clip in, tune in, and do something that has become automatic.

More recently, I’ve expanded my fitness routine. On the recommendation of my friend Corin Gearhart, I’ve added Barry’s Bootcamp. I’ve added SolidCore. And somewhere along the way, I’ve found myself in almost the best shape of my life.

What’s interesting is not just what I’m doing -- but why it’s working.

And the answer, unsurprisingly, comes back to habit, a topic near and dear to my heart.

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The Power of Context: Why Some Habits Stick

A few days ago, I was talking with my brother, an emergency room physician who recently transitioned to running an integrative medicine practice. We got into a discussion about fitness: what we do, how often, what works.

On the surface, we both exercise regularly. But there’s a key difference.

He works out individually. I work out almost entirely in groups. That difference matters more than it might seem.

In a group setting, habits are reinforced by:

• Accountability (people notice if you’re not there)
• Structure (class times, formats, expectations)
• Social reinforcement (shared effort, shared struggle)
• Consistency of context (same room, same cues, same rhythm)

Over time, the behavior becomes less of a decision and more of a default. I don’t wake up each morning and decide whether to go. I go because that’s what I do. Indeed, every Monday at 12p noon there is the ritual of selecting my SoulCycle bikes for the week.

That’s habit.

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A Parallel in Healthcare: Habits Don’t Live in Isolation

This conversation got me thinking about something we see every day in pharma and biotech.

We often talk about “physician behavior” as if it exists in isolation; as if prescribing decisions are made independently, by a single individual, in a vacuum.

But that’s not how healthcare actually works, and as we've deployed Habit Lens across multiple treatment categories, we've seen a consistent set of phenomena.

Physician decision-making and treatment selection habits, much like fitness habits, are embedded within a context -- and that context is almost always collective:

• A medical practice
• A hospital
• A health system
• A care team
• A tumor board

In other words, habit in healthcare is a team sport.

And that has important implications for how we study behavior -- and how we might strive to change it.

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The Hidden Complexity of Habit Loops in Clinical Practice

When we apply Habit Lens to help our pharma clients develop behavioral change strategies, one of the most important -- and often underappreciated -- questions is:

Who actually participates in this behavior?

Because in many cases, the answer is not just “the physician.”

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Example 1: Infusion Therapies

Consider a physician initiating a patient on an infusion therapy.

At the moment of prescribing, the physician is clearly central. But what happens next?

• The patient is often transitioned to an infusion center
• Ongoing care is managed by infusion nurses and staff
• The patient’s lived experience -- tolerability, convenience, satisfaction -- is often communicated to nursing staff, not directly to the physician
• Feedback loops are therefore distributed, not centralized

So while the behavior may appear to be “physician prescribing,” the habit is actually sustained by a broader team:

• Nurses who administer and observe
• Staff who manage scheduling and logistics
• Patients who provide feedback through different channels

If we only study the physician, we only see part of the habit loop.

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Example 2: Pediatric Vaccination

Vaccines offer another clear illustration.

From a high-level perspective, vaccination may seem like a straightforward physician-driven decision. But in practice:

• The physician communicates to the parent that a vaccine is needed
• Vaccination is an automatic, milestone process within pediatrics
• A nurse or medical assistant provides further education
• That same nurse often administers the vaccine
• Questions, concerns, and reactions are frequently voiced to the nurse, not the physician

This is basically an autopilot process:

• Triggered by age, schedule, or EHR prompts
• Executed through a well-established workflow
• Reinforced by routine and repetition

Here again, the habit is not owned by one individual; it is operationalized by a team.

And critically, the feedback loop -- which is essential for reinforcing or disrupting habit -- may never fully reach the physician.

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Example 3: The Role of the EHR

Increasingly, we also see the electronic health record (EHR) functioning as both:

• A cue (prompting action at a specific moment)
• A feedback mechanism (through alerts, flags, documentation flows, and the portal)

For example:

• A prescribing suggestion appears at a key decision point
• A protocol is embedded into order sets
• A reminder is triggered based on patient characteristics

Over time, these cues become part of the habit architecture. HCPs are not just responding to patients; they are responding to systems.

And those systems shape what becomes automatic.

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Why This Matters for Commercial Strategy

All of this leads to a critical insight:

If we want to understand, and impact, behavior in healthcare, we need to understand the full habit ecosystem, not just the individual decision-maker.

This has several implications.

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1. The “Target” May Not Be Who You Think

In some cases, the physician is not the primary lever of change. It may be:

• The nurse who administers therapy
• The staff member who manages workflow
• The "system" (i.e., EHR) that delivers cues at the point of care

Habit Lens research often reveals that influencing the physician alone is insufficient.

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2. Habits Are Harder to Break Because They Are Shared

Individual habits are powerful. But collective habits are even more durable. When a behavior is reinforced by:

• Multiple people
• Established workflows
• Institutional norms

…it becomes significantly harder to disrupt.

You’re no longer asking one person to change. You’re asking a system to change.

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3. Feedback Loops Are Distributed -- and Often Invisible

One of the most important drivers of habit is feedback. But in healthcare:

• Feedback is often indirect
• It may be filtered through other roles
• It may not be consistently captured or communicated

This creates blind spots. A physician may believe a treatment is working well because they are not receiving negative feedback...when in reality, that feedback exists, just elsewhere in the system.

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What Habit Lens Reveals

This is where Habit Lens becomes particularly valuable, especially when it is applied early in the discipline of market understanding. It allows us to:

• Map the full set of participants in a behavior
• Understand how context, cues, and feedback operate across roles
• Identify where habits are reinforced, protected, or vulnerable
• Determine where intervention is most likely to be effective

And importantly, it often reframes the question from:

• “Why aren’t physicians changing?”

to:

• “What system of habits is sustaining the current behavior?”

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Back to the Bike (and the Floor, and the Treadmill)

When I think about why my own fitness routine has worked -- and continues to work -- it’s not because I’ve suddenly become more disciplined. It’s because I’ve placed myself in environments where:

• The behavior is structured
• The cues are consistent
• The accountability is shared
• The feedback is immediate

In other words, I’ve aligned myself with a system that makes the behavior easier to repeat.

Healthcare is no different.

If we want new behaviors to take hold and flourish -- whether it’s prescribing a new therapy, adopting a new protocol, or reconsidering an existing default -- we must thoroughly understand the system in which those behaviors live.

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The System Behind the Behavior

Habit is often described as an individual phenomenon. In reality, especially in healthcare, it is often collective, contextual, and deeply embedded. And until we study it that way, we risk seeing only part of the picture.

Because behavior doesn’t just belong to people. It belongs to systems.

And systems, like habits, are remarkably good at staying the same -- until we truly understand how they work.