Social Norms vs. Market Norms

The Science Behind Social Norms vs. Market Norms

In his landmark 2008 book Predictably Irrational, behavioural economist Dan Ariely introduced a deceptively simple but profoundly important idea: human beings operate under two entirely different sets of rules, depending on the context of an interaction. The first set, social norms, governs relationships built on warmth, reciprocity, and mutual care. The second set, market norms, governs exchanges built on price, value, and transaction. The critical insight is not merely that these two systems exist, but that they are fundamentally incompatible. The moment you introduce a market norm into a relationship that was previously governed by social norms, the social norm collapses, and it is extraordinarily difficult to rebuild.

Ariely's research reveals that people operating under social norms are often more cooperative, more generous, and more loyal than those operating under market norms. When a neighbour helps you move house, you do not offer them a $50 note, doing so would be insulting, because it reframes a social act of goodwill as a commercial transaction. The same psychology operates in professional care relationships. When a patient sees their physiotherapist as someone who genuinely cares about their recovery, they are operating under a social norm framework. They feel loyalty, trust, and a sense of mutual investment in outcomes. But introduce explicit pricing, discounts, or promotional language into that relationship, and you have inadvertently flipped the switch to market norms, making the patient evaluate the interaction purely on commercial terms, just as they would when comparing insurance quotes.

This matters enormously for allied health practices because the therapeutic relationship is, by its very nature, a social norm environment. Patients share vulnerabilities, chronic pain, post-surgical anxiety, fear about their long-term mobility, and practitioners respond with expertise and genuine care. Research in health psychology consistently shows that therapeutic alliance (the quality of the emotional bond between practitioner and patient) is one of the strongest predictors of treatment adherence and return visit rates. When re-engagement communications disrupt this alliance by leading with commercial incentives, practices are not just sending a poorly worded email, they are psychologically repositioning themselves from trusted carer to service vendor.

The implications extend beyond individual messages. Ariely's work suggests that once market norms have been introduced into a relationship, it takes sustained social norm behaviour to restore the original dynamic, and sometimes the damage is permanent. For a practice that relies on long-term patient relationships, repeat visits, and word-of-mouth referrals, this is not an abstract concern. It is a direct threat to practice sustainability. Understanding this principle gives practice owners a clear framework: protect the social norm environment at every patient touchpoint, including, and especially, in re-engagement communications.

The Research

How to Apply This in Your Practice

The first step in applying this principle is conducting an honest audit of every re-engagement communication your practice currently sends. Print them out or pull them up on screen and ask a single question: does this message sound like something a friend who happened to be a health professional would send, or does it sound like something a retail store would send? Phrases like 'limited time offer,' 'book now and save,' or 'returning patient discount' are pure market norm language. They may feel familiar because they are borrowed from consumer marketing, but they are actively harmful in a therapeutic relationship context. Flag every instance of transactional language and treat it as a re-engagement leak.

Once you have identified the problem, the rewrite principle is straightforward: lead with genuine clinical curiosity, not commerce. A re-engagement message operating under social norms might read: 'Hi Sarah, it's been a while since we saw you, and [Practitioner Name] mentioned they've been wondering how your lower back has been holding up since you finished your program. Have things been tracking well? We'd love to hear how you're going.' Notice what is absent: there is no price, no offer, no call-to-action to 'book online.' The message demonstrates memory, care, and continuity, the three pillars of a social norm relationship. It treats Sarah as a person with a history, not a lapsed revenue source. If Sarah responds, the conversation can naturally lead to a booking without ever introducing market norm language at the outset.

For practices using SMS or email automation, this principle can be systematically built into your communication sequences. Segment your lapsed patients by the clinical reason for their last visit and write condition-specific re-engagement messages that reference their actual treatment journey. 'We know shoulder rehab can feel like two steps forward, one step back, how has yours been travelling?' is infinitely more powerful than a generic 'We haven't seen you in a while!' because it demonstrates that your practice remembers and cares. Where possible, personalise with the practitioner's name rather than the practice brand, people have relationships with people, not with logos. The message should feel like it came from a practitioner, not a marketing system.

Finally, if your practice does want to offer an incentive to returning patients, timing and framing matter enormously. Do not lead with the offer. Establish the social norm first, make contact, express genuine interest in the patient's wellbeing, and invite a conversation. Once that relational connection has been re-established (ideally through a reply or a booking), any subsequent mention of a fee adjustment or special arrangement lands within the context of a caring relationship rather than a commercial pitch. The sequence matters: relationship first, logistics second. This approach preserves the social norm environment while still allowing your practice to use practical incentives where they genuinely make sense.

Seeing It in Action

Your Action Plan

1. 1Audit every automated re-engagement message in your current system and highlight any market norm language, discounts, offers, pricing references, or promotional calls-to-action, then flag these for rewriting before your next send.
2. 2Rewrite your re-engagement templates using social norm framing: open with genuine clinical curiosity about the patient's condition, reference their specific treatment history where possible, and send from the practitioner's name rather than the practice brand.
3. 3Segment your lapsed patient list by condition or treatment type and create condition-specific message variations, a patient who came in for post-natal pelvic floor rehab should receive a fundamentally different message to one who was managing a rotator cuff injury.
4. 4Train your front-of-house team to follow up any patient response to re-engagement messages with a warm, conversational phone call before mentioning appointment availability, restore the relationship verbally before moving to scheduling logistics.
5. 5If you choose to offer returning patient incentives, introduce them only after the relational connection has been re-established, as a logistical afterthought, not a headline, so the gesture reads as care rather than commerce.