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Insights from behavioural economics can help independent pharmacists understand why patients behave the way they do, as Trevor Gore explains…

There is a myth that at the first sign of illness, people google the symptoms or rush to the community pharmacy. The reality most of us do…nothing. We wait and hope it will pass.

And only when symptoms start to interfere with work, sleep or daily life do we finally act. Understanding this behaviour is important because it reveals a lot about how patients make decisions about illness and treatment.

Insights from behavioural economics can help pharmacists understand why patients behave the way they do and how pharmacy teams can better support them. There are several biases at work here.

One is optimism bias, which is the belief that things will probably turn out fine. Another is status quo bias, where people prefer not to change what they’re doing unless they really have to, and seeking advice takes time and effort, so when symptoms feel minor, it’s easier to carry on and monitor them. An example is the common cold.

Feeling of mild irritation

It usually begins quietly, with a slightly scratchy throat or a feeling of mild irritation. Most people ignore it at first, blaming tiredness, dehydration or the weather.

Few people seek advice at this stage, but over the next day or two, symptoms typically develop further. The sore throat becomes more noticeable, sneezing begins and the nose starts to run or feel blocked.

Some people may start self-care at this point, perhaps a lozenge, hot drink or a decongestant picked up during a supermarket shop.

By around day three or four, symptoms often peak, and a cough may develop, congestion gets worse and people begin to feel tired and run down. It’s usually at this stage that patients start to seek advice from a community pharmacist.

This gradual decision pathway of ignore, monitor, self-treat, then seek advice, is extremely common. From a behavioural perspective, it reflects what behavioural economists call present bias.

People prioritise what feels easiest in the moment rather than what might be beneficial in the long term. If the symptom is mild today, the effort of seeking help can feel unnecessary.

Because patients rarely act immediately, community pharmacies often become the first professional contact point once symptoms progress. This gives pharmacy teams a unique opportunity to influence decisions about treatment, self-care and when further medical advice is needed.

Pharmacists are highly accessible healthcare professionals, where patients can walk in without an appointment, often during extended opening hours, and speak to someone they trust. That accessibility is one of pharmacy’s greatest strengths within the NHS.

Services such as Pharmacy First, the Community Pharmacist Consultation Service (CPCS) and the New Medicine Service (NMS) already place pharmacists at the centre of supporting patient decision-making. But behavioural insights suggest there may be even more opportunity to guide patients in subtle but powerful ways.

Behavioural economics doesn’t aim to force people into particular choices but rather focuses on small changes in the way choices are presented, often called “nudges”, that make healthier decisions easier.

One important concept is framing which is about changing the way information is communicated and can significantly influence how patients interpret it.

For example, saying “this medicine can reduce your risk of stroke” may be effective, but for some patients a loss-framed message such as “not taking this medicine increases your risk of stroke” may be more motivating.

Another useful principle is social norms because people are strongly influenced by what they believe others are doing, so a simple phrase such as “most patients with your condition take their medicine every day” can reinforce adherence by making the behaviour feel normal.

Simplification is another powerful tool. Health information can be overwhelming, especially for patients managing multiple conditions or medicines, but clear, concise explanations and simple dosing advice can make a big difference to understanding and adherence.

Pharmacy teams also play a role in helping patients build healthy habits. Linking medicine use to everyday routines, such as taking tablets with breakfast or keeping inhalers beside a toothbrush, can help transform medication use from a conscious decision into an automatic behaviour, or habit.  

Behaviourally informed approaches are already being used across the NHS and famously reduced inappropriate antibiotic prescribing by sending GPs letters showing how their prescribing compared with that of their peers.

The simple reminder that “most practices prescribe fewer antibiotics than you” led to measurable changes. Similar ideas can work in pharmacy, by encouraging early self-care for minor illness, normalising adherence behaviours or simply explaining how a condition typically progresses can help patients make more informed choices. 

When we look at how patients actually behave, it becomes clear that healthcare decisions are rarely instant or rational. Most people move gradually through stages, first noticing symptoms, then waiting to see what happens, and finally trying self-care and finally seeking advice.

Community pharmacies sit right at the point where that decision shifts from self-care to professional guidance. By understanding the behavioural factors behind patient decisions, and by using simple communication techniques, pharmacists can help patients manage illness more effectively.

In a healthcare system under increasing pressure, these small behavioural insights could make a surprisingly big difference.

Trevor Gore is the founder of Maestro Consulting, a Self-Care Forum trustee and associate director at the Institute for Collaborative Working.