You write a clinic's name on a sticky note and hand it across the desk. What happens next is mostly out of your hands. Whether the patient calls depends on a set of calculations they make on the drive home, and most of them never say those calculations out loud.

Our survey asked 443 adults across the Midwest to run those calculations for us. The questions were about newer depression treatments such as esketamine and ketamine therapy, and the answers are summarized below as the questions referring clinicians tend to ask us. Every figure is a top-line result from the full sample, taken from the validated final data.

What is the first thing patients look for in a provider?

Coverage, by a wide margin. We asked people to name the two attributes that mattered most when choosing where to get this kind of treatment. Coverage was one of the two picks for 85 percent of the people answering. For comparison, the next most common choice was proximity at 43 percent.

How much does distance really matter?

More than many referrers expect. Being near home finished second among the attributes, ahead of speed, FDA approval, privacy, and specialization. With esketamine, the reason is partly logistical. The nasal spray is given at a certified site with a stretch of observation after each dose, and nobody drives themselves home that day. Frequent visits early in treatment make a long commute a real barrier.

Do patients care how quickly a treatment works?

Some do. Speed landed in 24 percent of respondents' top two, just behind FDA approval at 27 percent. That is meaningful but well behind coverage and distance. No one can promise a timeline, and the survey did not measure outcomes. If a patient asks how fast it works, the honest answer is that it varies and the treating clinician will discuss what to expect.

Does FDA approval matter to patients, or only to us?

It matters to them. Two different questions bear on this. As one of two top attributes, FDA approval was picked by roughly a quarter of people. Asked more directly whether approval would sway them, 59 percent called it deciding or big. That second figure combines 19 percent who said deciding and 40 percent who said big.

This is a reason to be precise about what you are referring to. Spravato is the brand name for esketamine; the FDA approved it for depression that has shrugged off earlier treatment, and it is only given under supervision at certified sites. IV ketamine is used for depression off label, and ketamine mailed to someone's home is a separate and looser model. Patients who care about approval deserve to know which one is on the sticky note.

Will patients put up with prior authorization?

Most will, if they know it is coming. Offered insured care with more steps or simpler self-pay, 51 percent of respondents picked insurance. A quarter preferred to pay themselves, and another quarter did not know.

The practical move is to warn them. "The clinic will probably need approval from your plan first. That can take some time. It is normal, and it does not mean you were turned down." Include their medication history in the referral so the clinic can document prior trials.

Which payers should my referral list cover?

More than you might think. Our respondents could pick every coverage type that applied to them. Commercial plans topped the tally with 39 percent; Medicaid trailed by a couple of points, at 37 percent. Then came Medicare with 23 percent, the uninsured with 9 percent, and TRICARE households with 5 percent.

A referral list built around commercial carriers alone misses a large part of the population. For each clinic you use, ask which Medicaid managed care plans it accepts, whether it bills Medicare, and whether it is TRICARE authorized. For uninsured patients, know whether any nearby option offers a sliding scale or a community health center pathway. If a patient wants to see how costs and coverage usually work before calling, this overview of treatment costs and insurance lays it out.

Do patients want in-person care or telehealth?

Most want a clinic in the mix. Respondents chose fully in-person care most often, at 44 percent. A start-in-clinic, finish-at-home model drew 23 percent, home telehealth 22 percent, and the undecided 11 percent. Put in-person and hybrid together and 67 percent of respondents want a clinic somewhere along the way.

That fits how the approved product works, since esketamine is given on site.

Should I use the brand name when I bring it up?

Use it, but do not lead with it. Nearly three quarters of the people we asked, 73 percent, did not know the word Spravato at all, and another 21 percent had heard the word yet could not have told you its meaning. Opening with the brand gives most patients nothing to hold onto. Start with what it is and how it is given, then name it so they can look it up.

How much does my recommendation actually move people?

This is the strongest finding in the study. The voice most likely to get respondents to try it was their own doctor's, named by 74 percent. Ads managed only 2 percent, and podcasters 1 percent. Friends and family drew 18 percent. Your word carries far more weight than any campaign.

Pair that influence with a clinic that fits the patient's coverage and location.

What if the patient is not safe to wait for a referral?

Then the referral is not the priority. A patient describing suicidal thoughts needs your practice's safety protocol now, and they should leave with the Suicide and Crisis Lifeline in hand, at any hour. They can call or text 988; veterans who dial can press 1.

Where this stops

These answers show how people choose care. They are neither clinical evidence nor medical advice. Whether any treatment fits a given patient is a decision for the clinicians involved.

Methodology

The Pollfish consumer panel hosted this survey until June 23, 2026. It collected 443 finished responses from people 18 to 64 in Oklahoma, Wisconsin, Indiana, Minnesota, Missouri, Iowa, Ohio, Nebraska, Illinois, and Kansas. We cite top-line results here, and questions allowing several answers sum to more than the sample. Pollfish has since completed its validation, and every number here matches that final dataset. Our publisher paid for the survey and commissioned it directly, so read it with that interest in mind.