The truth about a doctor's day: know-it-all patients and no time for lunch
Science-fiction buffs often conjure up visions of medical care whereby the physical exam is supplanted by a scanner, face-to-face interaction occurs via screen, and the doctor-patient relationship gives way to a cyborg in a white coat.
Most people don't want to see the venerable physician replaced by a computer. Yet, some would say, the onslaught of medical information empowering consumers is making the above scenario seem more like inevitability than fantasy.
According to new research conducted by McCann Health, doctors see a big disadvantage to technology — it's often being used to second-guess human medical judgment. It's as if data from the web and from wearables has predetermined clinical decision-making, rendering the office visit a mere fait accompli. A companion consumer study also conducted by McCann Health points the finger at millennial patients for exemplifying the trend.
This is just one area of tension manifesting as doctors' view of their profession clashes with today's changing healthcare dynamic. And the biopharma industry, for its part, needs to embrace a very different definition of doctors' roles and responsibilities.
“We don't know if doctors will be extinct or not. We don't know if the entire profession will change,” Amar Urhekar, president of McCann Health Americas, said at an event to unveil the study findings, “but we truly believe there is something dramatically happening.”
As part of the Truth About Doctor's study, 450 physicians — 70% specialists and 30% PCPs, split evenly among men and women, and representing a wide age range — were surveyed by the health communications network in partnership with McCann Truth Central, the global intelligence unit of parent company McCann Worldgroup, to get to know the human behind the white coat. It was the first of a three-part series designed to explore “the untold truth about health in America.” Next in line are the Truth about Patients and the Truth about Pharmacists report.
For the Doctor's study, McCann employees asked specialists and internists such questions as what stories they tell at the dinner table and what they would have done had they not entered medicine. What emerged were four key pillars underpinning what the researchers call “doctorness:” it's anchored by authority, built on relationships, centered around trust, and fueled by gratitude.
Those four pillars are under stress. For instance, data from the Truth About Wellness consumer survey shows that 32% of Americans ages 18 to 34 years old think that they could be a doctor with little or no training, a statistic which — while fascinating in a bizarre way — suggests the younger generation doesn't value the years of training doctors undergo.
At the reveal hosted at McCann Worldgroup's Manhattan offices earlier this month (pictured), study co-authors Hilary Gentile and Laura Simpson showed a clip from a 2015 episode of “Jimmy Kimmel Live!” The comedian delivered a monologue about the anti-vaccine movement, which was followed up by a pre-recorded video (skip to 4:50) of several physicians defending their training and delivering a not-so-gentle reminder to people — particularly parents who haven't vaccinated their kids.
Moreover, the wellness survey showed, one in five patients said they trust their pharmacist more than they trust their doctor. “Authority is being questioned, the relationship is being challenged, trust is being eroded, and there is a lack of gratitude from doctors' point of view,” said Simpson, who is EVP and global director for McCann Truth Central.
“How doctors define themselves is in conflict with how the world is changing,” added Gentile, who is EVP and chief strategy officer for McCann Health North America. “Doctorness — the traditional way doctors practice medicine — is in jeopardy.”
Indeed, physicians expressed skepticism as to whether the increased transparency of information today, with sites like ZocDoc allowing easy access to doctor reviews and wearable technology like FitBit generating all sorts of data, was actually helping the unhealthy or enabling a sort of tyranny among patients.
Simpson and Gentile identified several other ways in which doctorness is at odds with the new dynamic. Compounding the tension of transparency versus tyranny is one they call human versus machine, whereby patents' expectation of doctors to act with machine-like perfection contrasts with their need for them to be human beings. “We want them to be the ultimate caring ally,” said Simpson. “At the same time, we don't want to see their humanness or know they're fallible.”
Hilary Gentile (left) and Laura Simpson (right), present the findings of McCann Health's Truth About Doctor's study.
Mounting pressures for documentation don't sit well with the medical set, either. “Doctors are the ultimate matrix thinkers,” she said. “They are artists and humanists. They want to solve problems by looking at things in many different ways. They don't want to be handed a sheet and protocol and told, ‘This is the data and what I should be doing.'”
Then there's care versus commerce, in which HCPs are stripped of their autonomy by health systems that heap pressure on them to save lives while seeing more patients in a shorter amount of time. These trends clash with the factors that drove physicians into medicine in the first place.
“Doctors were at the heart of the ecosystem and everything revolved around them, including the patient,” explained Simpson. “Now, the patient is at the heart of ecosystem and the physician is just one stakeholder amongst many.”
The keynote speaker at the McCann Health event, Dr. C. Michael Valentine, an interventional cardiologist who is also incoming vice president of the American College of Cardiology, said that the personality traits among the typical doctor — competitive, type-A perfectionist, compassionate, desirous of a stable job, and very independent — haven't changed all that much.
What is shifting is the demographic makeup of physicians across the country. According to data from a 2014 national survey he cited, 73% of cardiologists in the country are employed. “We're now in the corporate structure,” said Dr. Valentine, whose Lynchburg, Virginia, practice merged with a health system a decade ago.
“That will impact every one of you as to how you approach the corporation as opposed to the family physician,” he said. “Marcus Welby ain't there anymore.”
How are doctors coping with this kind of pressure? When asked to rate their most important resources, time was number one. On the low end, only 3% cited the biopharma sales rep.
Mental energy, their team, a sense of humor, and the Internet were among the other resources HCPs said they draw on. Interestingly, there was a much higher reliance on empathy for older doctors and much less on the Internet, while the opposite was true for younger doctors.
“This begs the question,” said Gentile: “Is knowledge becoming more of a resource for younger doctors vs. caring, compassion and empathy?”
See also: Engaging HCPs: Beer or Tacos?
To be sure, three-quarters of all physicians said they believe access to technology — on balance — is also a good thing for their patients because it makes them more proactive about their health and in getting checkups. Most surprising of all, said Gentile, was that 84% selected humor as one of the top three resources they rely on to defuse their daily pressures.
“As you think back to interactions with doctors, the stories they tell and how humor defuses it, it's amazing [that] when we do visual aids [for reps to show doctors],” she said. “Why haven't we used humor more?”
In fact, most of the tools marketers have at their disposal date back to an era when information about brands was passed down to KOLs and then out to prescribers in what John Cahill, global CEO of McCann Health, termed “presentation mode.” “Yet, unless you've all fallen asleep, we've moved into a conversation paradigm,” said Cahill at the Truth About Doctors event.
Read more about the implications for industry.
IMPLICATIONS FOR INDUSTRY
Laurie Olson (left), EVP of strategy portfolio and commercial operations at Pfizer; Dr. Steve Zatz, president of WebMD; Shilpa Shah-Mehta, an executive director for Novartis in the oncology marketing area; and Marc Iskowitz, editor in chief at MM&M
What does this era of conflicted care mean for marketers in the health vertical? “Pharma should expect a more complex, inquisitive, but time-starved doctor,” Cahill said later in an interview. “Our ‘Truth About Doctors' study reveals how engaging with this doctor will require a better understanding of their human needs and stresses. In turn, doctors need pharma to help develop more customized communications to make increasingly complex information easier to understand and act on — we see this as a paradigm shift from presentation to conversation.”
A panel discussion, moderated by this reporter, was designed to delve into how doctors' roles and responsibilities are set to change over the next 15 years and to talk through ramifications for the pharma industry. “Most of us could live with computerized banking from end to end,” said Dr. Steve Zatz, president of WebMD. “How many of us would want a computerized, fully technical experience when it comes to either our health or our loved ones' health, where we want the facts but we want someone to synthesize it; we need someone to talk to.”
Indeed, no one argued for reverting to the family doctor type of relationship of old, but rather utilizing technology so that it enables human relationships instead of replacing them. “Maybe as an industry we need to think not so much about going back, but nurturing the new physicians who are going to take the place of those physicians who are so frustrated in the current reality and really nurture [them],” suggested Laurie Olson, EVP of strategy portfolio and commercial operations at Pfizer.
Helping physicians reach a happy medium with technology is a fine balance, though, said Shilpa Shah-Mehta, an executive director for Novartis in the oncology marketing area. She pointed to electronic health records as one example. One the one hand, clinicians are so consumed with them, because they know that if they don't use them, Medicare reduces their payments.
On the other hand, Shah-Mehta shared an anecdote about an oncologist who constantly complained to her about his EHR. “It was very surprising that this one system could change the way he felt about treating patients,” she said. “Will there ever be an opportunity to standardize it or help aggregate it somehow?” She added, “We can't control the [EHR] system, but can we at least provide information that will make it a little easier for them to change the systems?”
In the meantime, Dr. Valentine shared a solution to the problem of EHRs threatening to change the way he interacts with patients, one that is gaining steam across medicine: “Guess what — I hired a scribe. A 22-year-old scribe keeps me off the computer, so I can talk to you...We're looking for ways to connect better with patients.”
Among other things industry can do to preserve doctorness, Zatz stressed the importance of “preparing doctors for that more educated patient” and keeping patients informed in between office visits, after which they are usually sent back to self-care to manage their conditions. “You have to educate both,” he said. “It's not one or the other.”
To see how out-of-date industry communications are with the changing landscape, one need only juxtapose them against the way that patients as people — not even as patients — communicate.
“When we think about the life of the patient outside of the healthcare system, it's very dynamic — lots of communications going on back and forth all over the Internet, whether family and friends or work colleagues,” Olson observed. “But when you look at communications around healthcare, particularly pharma communications, they tend to be one-way, very authoritarian, no give and take whatsoever, highly scientific, not in [patients'] language. [The way] we engage with them is so very different. The challenge for all of us is how do we get closer to that norm.”
One way is to become more comfortable with using unbranded communication. “We recognize many institutions specifically do not allow branded material,” said Shah-Mehta, in response to a question on how to facilitate doctor-patient dialogue. “What we find is when we say ‘disease education' or if it's unbranded, it still has your company name on it and even that sometimes becomes a challenge in some of these institutions.”
Supporting new physicians will also require helping them aid patients along their journey, even if the trip veers into uncharted territory. Olson recalled a town hall meeting at Pfizer during which a patient recapped her experience with metastatic breast cancer, describing a clinical trial of a drug in development that ultimately ended up working for her.
“That story is so different from typical patient stories of the past where the hero of the story was almost always the physician,” recalled Olson. “Here, the hero was the empowered patient and somewhere in that story was a physician who was accepting of that…and, when she printed out an academic article and brought it to him, he didn't say, ‘I know better,' but actually read it and helped her in the journey.”