The un-empowered patient

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It's become part of received wisdom that today's patient is an active partner in his or her medical care. Since we all accept this as fact, we don't think it's worth questioning.

But perhaps it is: a new research study concludes that most of today's supposedly empowered patients don't ask the doctor what their prescriptions are for or about the benefits or risks. Only rarely do they even answer questions with more than a “yes” or “no.” No dialogue, hence no participation.

And here's another shocker: The standard DTC call to action of “ask your doctor” doesn't work. There's data to show that 97 out of 100 of your prospects do no such thing.

Hearing these conclusions caused listeners to sit up in their chairs in surprise at a Coalition for Healthcare Communication meeting earlier this year where Joe Gattuso, the director of strategic insight for the 13 CommonHealth agencies, Power-Pointed them.

For years we have relied on studies, such as those by Prevention magazine, that show that DTC promotion works. And so it does. But how? What actually goes on in the doctor's office when patients exposed to these ads see their doctors? Do they say, “doctor, I saw this ad” or do they ask for, or about, a specific brand? Do they, in fact, give any indication of having been “empowered?”

CommonHealth set out to answer these questions, Gattuso reported, and now has a database of more than 2,500 transcriptions of videotaped doctor/patient encounters. For this particular study, they analyzed 440 office visits, covering 35 therapeutic categories, looking for either direct or indirect mentions of DTC advertising by either party. In addition, they identified all direct statements regarding product benefits or risks made by the physician.

Concentrating on three conditions (allergy, elevated cholesterol, and hypertension) that were being widely promoted through major ad campaigns at the time, they then followed up with post-visit interviews with both the doctors and the patients. Patients were asked, “Were there questions you felt the doctor didn't answer? Or issues you wanted to know more about? If so, why didn't you ask?”

“I didn't know whether I should ask that,” they responded. As for the doctors, reviews of the transcripts showed that 60% of the time they provided neither risk nor benefit information, and that, for their part, they felt sure their patients had left the office satisfied.

Clearly, while we have had evidence that DTC works, we didn't know why or how. Says Gattuso: “What is most significant [about] these studies is that they point the way to a new and expanded vision for DTC advertising—one which we believe will encourage and increase the kinds of dialogues we want [between] physicians and patients, resulting in more efficient, robust, and appropriate outcomes.”

He cites specific examples of how CommonHealth has applied its findings. Ads for Topamax, for instance, wind up: Tell your doctor your story. Other taglines might be: “Be sure to ask your doctor what your Rx is for,” or “Ask about the risk if I don't take this medicine.” Anything to open up a dialogue.

That approach could lead to real empowerment—and to better compliance that will improve both sales and patients' well being.

Warren Ross is editor at large of MM&M

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