The Doctor-Patient Disconnect

Jan 01, 2013

It's a scene that plays out in physician offices every day, and it's a critical moment for the patient and their doctor. After weeks of appointments, tests, and results, it's time for the conversation. The patient is anxious and confused. Today he sits on edge, waiting for a clear answer and an idea of what happens next.

The specialist has been through this many times before and is well practiced at delivering difficult news. She clarifies the diagnosis and prognosis, lays out a treatment plan, and is confident she has done her best to inform and assure the patient. She answers his questions patiently, gently explaining that not everything he's heard is true. She sends him off with a few sheets of specific information, a pamphlet, several drug samples, and prescriptions.

And the patient? He leaves, with information in hand, in shock. Although he suspected what was coming, it was a shock to hear it out loud. He had questions but didn't get to ask them all. He'd done research on the Internet but wanted to know more. And the specialist, as nice as she was, had other patients waiting and told him she'd see him in three months.

The conversation is changing

In today's increasingly complex healthcare world, communication between physicians and patients often doesn't work. The gap between what the physician has to say and what the patient wants and needs to hear is growing wider. And as that gap grows, trust breaks down.



Physicians are time challenged, attempting to see more patients during the day. At the same time, they have to comply with REMS programs and EHR record keeping and stay abreast of more complex drug regimens and administration. Patients are more informed and more demanding. They come in armed with information, both from the Internet and well-intentioned family and friends. Some is helpful and functional. Some is misleading, creating ambiguity and confrontations between physicians and patients.

The critical moment of truth, when the physician summons all of his or her experience and knowledge to help patients confront and cope with life-changing situations, is interrupted by new challenges. What we have come to call the "Clipboard Patient" has wrestled the control of the information (the clipboard) and control of their treatment away from the specialist. The result? Confused patients, frustrated physicians, and a potentially negative impact on therapy compliance and outcomes.

Pharmaceutical manufacturers, having invested heavily in research and marketing, seem to be unfortunately absent from the shifting conversation at a critical moment.

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Reconstructing the conversation

Clearly patients need to hear critical news directly from their physician. And clearly the physician needs to be in direct contact with their patients throughout the continuum of care. But neither party is alone in the process. And our research has shown that more and more physicians admit they need support in managing this new breed of patient.

That support can come from a number of players:

» Nurse practitioners and physician assistants, who want to play a broader role in patient care

» Office staff, who are on the front lines with patients every day

» Caregivers, who can help filter and interpret for their loved ones

» Pharmacists, who can provide and clarify information on drug therapies

» Pharma, who can position their brands, their salesforces, and their companies to support better practice and better physician-patient communication

Yes, even though pharma marketers aren't in the exam room at the critical moment of truth—when treatments are discussed and brand choices are made—they can facilitate the conversation that's happening and support decisions once they are made. Here's how.

Find the disconnects. Our market research among specialists and their patients has helped us identify the critical disconnects and unmet needs in their ongoing conversations. Often different for each specialty and drug, but the themes we've discussed are common. While most pharma marketers conduct a significant amount of market research on clinical needs, brand positioning, and messaging, only a few have focused on these critical physician-patient conversations. Conduct this type of research, and I guarantee you'll be surprised how much perception of the exact same conversation differs between patients and physicians.

For example, physicians may not discuss the course of a chronic disease at the time of diagnosis because it's too much for patients to handle. True to some extent, but there still are things patients do want to know—about what's going on in their body, about their medications, and so on.



Physicians have told us that patient anxiety at these important moments can bring out the full catalog of personality issues, creating barriers and minefields in meeting their treatment goals. Patients tell us how when they can't get answers or access to their physicians when they need to, dissatisfaction soon turns to mistrust.

Bridge the gaps. Once you discover where the disconnects lie, each insight becomes an opportunity to create a program that facilitates communication and decision making between physician and patient. Some programs are basic—such as simple in-office patient education tools on both disease and treatment. Other programs get more complex, such as patient programs operated outside the physician office. Providing access to nurse practitioners, offering comprehensive education, and even facilitating patient-to-patient networks can require a substantial investment. That level of support has shown to pay significant dividends in terms of brand understanding, patient perception, and relationship building at multiple levels.

At a minimum, ensure your physician group is informed and educated about your brand. Keep your speaker programs focused on content that helps them see how to apply your brand in clinical practice, so they are confident when confronted by the Clipboard Patient.

Reframe your sales rep's conversation. Armed with an understanding of the issues, a toolkit of support resources, and the incentive to build relationships not just increase scripts, the sales rep becomes a welcome ambassador for the disease state, not just a detailing robot. And isn't that the relationship that's often missing from your most important and expensive sales channel?

A rep now has the opportunity to communicate with physicians on their level, helping their physicians not only meet their treatment goals but their practice goals as well. Opening up discussions with the physician assistants, nurse practitioners, and office staff can also be beneficial, helping the reps uncover a variety of unmet needs within the office.

Connecting the dots

While reconnecting physicians and healthcare professionals with their patients is not about your brand's specific features and benefits, it is about your brand and company. Building relationships, solving customer problems, supporting best practices, and driving compliance all align with your marketing objectives.

Helping to rebuild a crucial disconnect in the process is the first step to reframe your brand as a problem solver, build top-of-mind awareness, and at the moment of truth, give you an added advantage.

Al Topin is President of Topin & Associates, and a member of Pharm Exec's Editorial Advisory Board. He can be reached at atopin@topin.com
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