dr. adam wolfberg is an obstetrician, a runner, and a writer.

The Five Stages of Grief (when doctors build apps)

Stage 1: Denial.

“We don’t need a digital strategy” -- this is the current state of thinking for many clinicians and leaders in healthcare. “Our patients don’t pay attention to apps, because patients know that we’re the experts,” they say as they remove pamphlets from cellophane packages and stock them in plastic holders in their waiting room. This is the first stage of healthcare app grief: denial.

Because I work for a digital health company, I make it a practice of asking my patients what pregnancy apps they use, and all of them use apps - typically two or three of them. I also make it a practice of asking my colleagues what pregnancy apps they think their patients use, and none of them have any idea.

Stage 2: Anger.

“The apps out there are terrible,” is the next refrain. This is both true and a representation of ostrich-like rectitude. There are a lot of bad apps, and a lot of good ones. However, since healthcare professionals don’t use them and don’t know what their patients are using - and because they are healthcare professionals and not product managers - they just vent their frustration. Every provider also laments, “Doctor Google,” which they know because they use Doctor Google too.

Stage 3: Bargaining.

Being clever and well-intentioned, the next stage of app grief is bargaining: Let’s build an app. The thinking goes like this: “My patients want to learn about my practice,” (or how to reduce their risk of having a cesarean, or what services my hospital offers, or how to learn about genetic testing, or how to decide whether to try labor after having a cesarean). “I’m the expert in that topic. I hired people to design my website and to run my practice, so I can hire someone to build me an app.” It’s easy: go to Google, search “app developers,” and before long, an app is launched, posters go up in waiting rooms, and patients are told about the app.

It’s worth pausing here to reflect on the purpose of an app. Great apps solve recurrent problems: Uber gets you where you want to go; Google Maps help you navigate from here to there; the New York Times lets me read the paper on my phone; Instagram connects you to your friends (celebrities and influencers); Strava connects me to my friends who exercise. I also have a handful of apps on my phone that I don’t like but have to keep there, buried in a folder on page two: The VPN security app, the one that lets me view the hospital’s electronic medical record when I’m away from my computer, and the one I have to use to let the city know that my garbage wasn’t picked up. All of these apps, whether I like having them on my phone or not, are solving recurrent problems.

Solely providing information is a poor use of an app, because the combination of Google and your website solves this problem more easily (for you and for your patients). Single-use apps, such as the ones that calculate your risk of successfully delivering vaginally after a cesarean or calculate your risk of some medical condition, are more easily and better implemented on the web (yes, you can imbed a calculator in your website.

Stage 4: Depression.

Then comes depression. “Why isn’t anyone using our app? It is so accurate, so great, so clinical.” I’ve heard this from dozens of clinicians and healthcare leaders. The explanations are myriad. “We tried, but patients just weren’t interested in our app.” “We don’t understand those millennials.” I’ve even heard, “patients prefer paper.”

Stage 5: Acceptance.

The next stage, acceptance, comes with the recognition that healthcare providers are experts at practicing medicine, and successful mobile technology innovators are excellent at building app experiences that are engaging and delightful. Success comes when healthcare providers team up with app developers to build something awesome together. Witness collaborations between mental health professionals and Facebook to identify suicidality; between hospitals and Uber to get patients to the clinic.

Once you reach acceptance, recognize the unmet opportunity that great existing apps open up to you: engaging your patients in their healthcare. I’m inherently biased, because I work for a digital health company that impacts millions of pregnant women daily. Your patients seek information and community between their visits with you, and the opportunity to partner with a team of digital engagement experts that already has your patients’ attention is profound. A handful of healthcare providers are partnering with my company and others, recognizing that while they are the clinical experts, we are expert at patient engagement. Smart healthcare providers are leveraging digital health solutions to communicate with their patients, influence the healthcare choices they make, and meet patients in the way they want to be met. That’s called collaboration.

More women experience postpartum depression than we think. Probably.