Tuesday, September 29, 2009


If you've been unlucky enough to visit your doctor recently, you may have seen a sign reporting how many appointments were missed last month - and possibly how much this was costing. The idea being to shame you, as a potential no-show, into not doing it again. The bigger the figure, the deeper the shame and the stronger the resolve to mend your ways.

But according to Danny Finkelstein's Radio 4 offering, Persuading us to be good, this is precisely the wrong approach. The logic goes that we want to feel part of a group, not isolated. Now being part of the group of patients that don't show is still being part of a group. And the bigger that group, the better it is to be part of. The stigma of having missed your appointment and wasted NHS time, money and resources isn't the main behavioural driver, association with others is. In fact one surgery reported a huge increase in no-shows as soon as they started to make this figure public.

The answer: tell people how many showed up for their appointment, implying that the no-shows are a minority of social outcasts and losers, not even worth a statistic.

I'm not sure just how watertight this approach is, but I do like the realisation that the instinctive, knee-jerk reaction can exacerbate exactly the problem it's meant to solve. And that being in a bad group is better than not being in a group at all.