When I started on the consumer telehealth app at Amwell, I pictured my user the way most designers do: calm, rational, reading every label I wrote. The person who actually showed up had a fever of 102 and a crying toddler on her hip. That gap — between the user we design for and the human who actually arrives — became the most useful lesson of my eight years there.

There is an old study about car wash loyalty cards. One group got a card with 8 empty stamps. Another got a card with 10 stamps, 2 already filled. Same 8 washes required — but the group with the head start finished at nearly double the rate. The closer people feel to the finish line, the harder they push toward it.

Now look at almost any onboarding: “0% complete.” Zero. You are telling a patient who just spent effort creating an account that they have done nothing. 0% feels like standing still. 20% feels like momentum. The work is identical — only the starting line moved. So count something they already did. Creating the account is step one. Why are we so stingy about giving people credit?

Every empty field on an intake form is a question, and every question is a small tax on a sick person’s mind. Psychologists call it decision fatigue — I call it asking a person with a migraine to do paperwork 😁. There is a famous grocery store study where 24 flavors of jam attracted plenty of lookers but almost no buyers; cut it down to 6 flavors and purchases jumped 10x. More choices don’t mean better. They mean harder.

If we already know the answer, don’t ask the question. Pre-fill what the system knows. Pre-select what most patients pick. Let the sick person scan and adjust, instead of filling out from scratch. Most users never change a good default anyway — not because they are lazy, but because a default reads like a recommendation from someone who knows better. Be that someone.

Most apps ask before they give. Sign up to continue. Enter your email to unlock. In healthcare this is even worse, because trust is not a nice-to-have — a person is about to tell your product things they might not tell their own family.

Let the product do something genuinely useful before it asks for anything. Show what’s available, what it costs, who the doctors are — first. This is reciprocity, the oldest trick of human kindness: when someone gives you something first, you feel a pull to return the favor. It is why free samples work absurdly well, and why the best sign-up walls never feel like walls. The user already received something worth coming back for.

Have you ever assembled IKEA furniture and then quietly admired it, even though it leans slightly to the left? Researchers call this the IKEA effect — we value what we build, far beyond its objective worth. There is an even lazier cousin, the ownership effect: you don’t even need to build it, just feeling it is yours is enough.

A standard sign-up page offers the user nothing to own, so closing the tab costs nothing. But let a person choose something — their preferences, their care needs, their profile — before the account exists, and everything changes. Leaving no longer feels like skipping a form. It feels like abandoning something they made. Remember: you are not collecting information, you are letting a person build their corner of your product.

The same price can feel expensive or feel like nothing — it depends entirely on what number the eye saw first. $79 alone on a screen invites mental math and doubt. $79 sitting next to what an urgent care visit costs suddenly looks like the reasonable choice. Restaurants have known this forever: the outrageous steak on the menu exists mostly to make the salmon look sensible.

Your brain does not evaluate anything in isolation. It measures everything against the thing it saw a moment before. So never show a cost on an empty page. Whatever number appears first becomes the ruler — make sure you chose it, honestly.