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After you’ve moderated enough interviews in healthcare, you eventually arrive -- almost without realizing it -- at a kind of professional epiphany:
Most of what we talk about with respondents isn’t really decision-making at all. It’s habit.
Early in my career as a moderator, everything felt immediate and transparent. I took respondents at face value. Physicians would describe how they evaluate patients and selected among treatment options. Their language was rational, deliberate, and well-articulated; and I believed it reflected what was actually happening. These were highly trained professionals, after all, making consequential decisions.
But after a while, something starts to feel off.
You begin to notice that you’ve heard the same story before. Not just similar logic, but the same structure. The same sequence. The same rationale, repeated with slight variation.
And when you start to press -- just a bit -- you begin to see what’s underneath.
Patterns emerge. The same actions follow the same cues. What presents as thought-intensive, deliberate decision-making is often a well-worn pathway: executed quickly, consistently, and with very little conscious effort. Even the delivery changes. When a respondent starts to speak more quickly, when the cadence tightens and the explanation compresses, it’s often a tell: this HCP is no longer describing a decision. He's describing a routine.
A physician in a busy clinic may believe, and may insist, that they are tailoring each prescribing decision to the individual patient. But in practice, a familiar patient profile -- appearing with a specific complaint, under a familiar set of circumstances and constraints -- triggers a default pathway. Within that context, the steps unfold automatically. Alternatives aren’t actively considered. The behavior runs on autopilot.
That is habit.
And once you see it, you start to hear it everywhere. From that point on, a behavioral science lens stops being optional -- it becomes essential.
Which leads to a different kind of question: not why someone made a decision, but how to systematically uncover the fact that, in many cases, the “decision” has already been made. And from there, the more challenging question: how do you identify the few, narrow openings where that behavior -- often deeply entrenched -- can actually be changed?
There is a persistent tendency in pharmaceutical marketing to assume that better data and stronger messaging will naturally drive adoption.
But that assumption overlooks something more fundamental: much of the behavior we are trying to influence is already 'spoken for.'
As outlined in our Habit Lens work and the volumes we've written about it, commercial teams consistently overestimate demand while underestimating the inertia created by ingrained behaviors. And in my experience, this gap is widening -- not narrowing.
Why?
Because the environment (or context) in which healthcare providers operate is becoming more compressed, not less. Time pressure is increasing. Cognitive load is intensifying. System constraints, whether administrative, technological, or economic, continue to expand. Despite the growing usage of AI as a workplace partner, physicians are still really, really busy.
In that environment, habit is not a flaw. It is a necessity.
It is what allows a physician to move through her full day of patients without having to reconstruct every decision from first principles. It is what keeps the system functioning. And it is not unique to healthcare; we all rely on heuristics and routines to navigate complexity.
But in clinical practice, the stakes and the structure amplify it.
Prescribing patterns, diagnostic pathways, treatment sequencing -- these are not reconsidered from scratch with each patient. They are routinized. Streamlined. Embedded within the fabric of clinical practice. Reinforced not only by individual experience, but by office workflows, peer norms, and increasingly, the digital infrastructure of modern care.
Which means that new therapies are not simply competing on clinical merit or message clarity. They are competing against behaviors that are already in place -- behaviors that are efficient, familiar, and often therefore invisible to the person performing them.
This is where much of the industry continues to struggle.
We attribute underperformance to awareness gaps, to messaging, to access. And while those factors matter, they are often downstream of something more fundamental: behavioral inertia.
Until we develop a more precise understanding of how habits form, how they persist, and how they can be shifted, we will continue to see the same pattern: strong assets underperforming not because they lack value, but because they fail to displace what is already there in a timely manner.
Habit sits just below the surface of awareness.
Ask someone why they do something, and they will give you a reason. That reason may be valid -- but more often than not, it is incomplete. The more I’ve approached interviews through using our Habit Lens framework, the more I’ve come to recognize that respondents are often explaining behavior that is already in motion.
They are describing it after the fact.
As Charles Duhigg and James Clear have both demonstrated, much of human behavior is cue-driven and automatic. It does not require active deliberation in the moment. Which means that when we ask “why,” we are often getting a rationalized (therefore biased) reconstruction layered on top of a process that has already run its course.
In healthcare, this dynamic is amplified by environment -- in other words, context. Behavior is not shaped by the individual alone. It is shaped by the system in which that individual operates and its rules and constraints (most of which don't get discussed and surfaced during the typical 60-minute interview):
These factors do not just influence behavior; they stabilize it and make it consistent. They create the conditions under which habits form, persist, and become difficult to dislodge.
Which means a single behavior -- a prescribing decision, for example -- is almost never a standalone act. It is one expression of a broader, interconnected system of habits operating within a defined context.
And that is what makes habit so difficult to study. It is not hidden; but it is embedded.
To understand it, you have to move past surface-level explanation and systematically unpack how the behavior actually works.
Which is precisely why a structured approach is not just helpful -- but necessary.
Over the past several years, my research and innovation team at ThinkGen and I have found it useful to think about Habit Lens work not just as analysis, but as a pathway:
(1) Ask the right questions → (2) Reveal how the behavior actually works → (3) Identify actionable steps required for change
This sounds simple. In practice, it requires discipline. A Habit Lens project is an intellectual heavy lift, that's for sure.
The starting point is typically the same: isolate a specific behavior and reconstruct it in detail.
This aligns closely with what researchers like Nir Eyal and Neale Martin describe as understanding the trigger-action-reward system that underpins habit. But getting there requires precision in questioning.
Anchor in Recent Reality
Isolate the Cue
Map the Sequence
Probe for Signs of Reinforcement
Detect Automaticity
Unpack Context
These are not new questions. What matters is how systematically -- and persistently -- they are applied to the same behavior. The goal here, and this is a critical distinction, is not to understand what someone believes they do. It is to understand what they actually do.
Once the behavior is mapped, the next step is to make sense of it structurally.
Across the literature, from Duhigg’s habit loop to Clear’s focus on cue-driven identity and Eyal’s work on triggers and rewards, the same core idea emerges: Habits essentially are systems.
In practice, we are looking to reconstruct four key elements of that system:
Every habit is triggered by some cue. In healthcare and the types of clinical care context that pharma markets strive to examine, cues are often:
The specificity matters. Vague cues are not actionable cues.
This is the behavior itself -- but understood as a sequence. Not just what happens, but how it unfolds. For example:
This is where habits often reveal their efficiency as well as their rigidity.
No habit persists without reinforcement. In clinical care settings, this is a critical -- and often misunderstood -- point: reinforcement is rarely about clinical outcomes alone.
We tend to assume that behavior is sustained because it is clinically correct or evidence-based. But in practice, what keeps a behavior in place is far more immediate and pragmatic.
More often, reinforcement comes from a combination of factors:
These reinforcements are subtle, but powerful. They operate in the moment, often unconsciously, and they build over time. Which is why understanding reinforcement is so important: because it defines what you are actually competing against.
Not just a preference. Not just a decision. But a behavior that is continuously rewarded for staying exactly as it is.
This is where healthcare meaningfully diverges from many other categories. Habits are rarely individual. They are embedded in systems. They are shaped and reinforced by:
Over time, these forces don’t just influence behavior -- they standardize it. They create a kind of local gravity, where certain actions become the default not because they are actively chosen each time, but because they are structurally easier to execute.
As Neale Martin has argued, behavior is as much a function of environment as it is of individual psychology. Which has an important implication:
Changing a habit is rarely just about persuading the individual.
It often requires engaging with the system that sustains the behavior in the first place.
Once the habit is understood, the question then becomes: what can be done? At a very high level, there are three strategic pathways, each grounded in behavioral science, and each requiring a different approach.
If the current behavior is a barrier, the goal is to interrupt the automatic loop. Traditionally, this involves one or more of the following:
But disruption alone is insufficient.
As the literature consistently shows, new behaviors must be:
...before they become habitual.
In some cases, the opportunity is not to break an existing pattern, but to establish a new one. Here, the focus should be on:
In his book, Atomic Habits, James Clear describes this as making behaviors “obvious, easy, and satisfying.” In healthcare, this often translates to reducing friction: through market access, workflow integration, patient support and education, or clarity of use.
Sometimes, the most effective strategy is simply alignment. Like brushing and flossing. If an existing habit is already strong and beneficial, the opportunity is to:
This is often the least disruptive, and most scalable, path.
Indeed, when I think back to the first Habit Lens project we worked on, this was indeed the key insight: you are not going to displace the current habit. Therefore, you should try to live alongside that habit.
As I noted above, Habit Lens research is not easy. As a moderator it requires a great deal of discipline and finesse. Some notable guide points are:
But with repetition, it becomes possible to do something quite powerful:
To take a behavior that feels opaque and automatic -- and make it visible, structured, and actionable.
In healthcare, the gap between intention and action is where strategy often succeeds... or fails. Habit sits at the center of that gap.
The good news is that it is not unknowable.
With the right methodology -- anchored in disciplined questioning, informed by behavioral science, and applied consistently -- it is possible to:
And ultimately, that is the goal. Not just to understand behavior.
But to shape it -- intentionally, systematically, and with a clear behavioral change plan.
