IN A WORLD OVERFLOWING WITH INFORMATION, most people—including doctors—learn to ignore all but a tiny fraction of the
unsolicited material sent their way. Most of the time, that's a good strategy. People could not be productive if they paid
attention to every scrap of information they see. Unfortunately, pharmaceutical companies, like most other providers of medical
information, assume that doctors consume all the information they receive. So they send as much as possible. If the doctors
can't use the data now, pharma seems to think, they dutifully file it away and utilize it when necessary.
In fact, doctors are at least as selective as anyone else. Our qualitative and ethnographic research, which includes thousands
of physician interviews and hundreds of hours spent observing their behavior, suggests that doctors look for certain types
of information in particular formats at particular times. Most of the rest they ignore. In the best of cases, it becomes casual
professional reading when they have a spare moment. So if the pharmaceutical industry provides important information in the
wrong place or in the wrong format, physicians miss it. If the industry wants its information to be more valuable to doctors,
it needs to think about how doctors will be using it, and where and when they expect to find it.
Prescription for effective communication
The first big lesson: Physicians do not think about undifferentiated information. They are concerned about certain kinds of
information that they require in different amounts, in different forms, and with different frequencies and timing.
When questioned in depth on the topic, physicians report that they think about two major types of information: point-of-care
and clinical updates.
Point-of-Care information offers physicians immediate answers to questions arising when they treat a particular patient. For example, physicians
might want to know whether patients taking other drugs can safely take a particular medication. Sometimes, physicians see
patients presenting clinical conditions that they have rarely—or in some cases never—previously encountered. Younger, less
experienced physicians need this type of point-of-care information most often. But novel medical conditions come up for everyone
in the hospital emergency room, and even in the treatment room at a private doctor's office. And when they do, the physician
is expected to do something about the situation right away, often without the opportunity to consult a colleague or start
a time-consuming information search.
Updates provide doctors and other prescribers with new information about medications. In particular, doctors need specific information
about side effects and contraindications. In addition, physicians want to receive guidelines about the treatment of particular
conditions from their specialty's accrediting organization (e.g., the American Academy of Pediatrics).
Even though doctors may want and need both of these types of information, the similarities stop there. Each type of information
needs to be delivered in a different but appropriate way.
In general, doctors need point-of-care information when a new situation arises, and they want immediate access to it. This
information is pulled (perhaps from a database) by the doctor rather than "pushed" in e-mail or other media by the information provider.
These situations require the greatest timeliness in two different senses of the term. First, the information provided must be up-to-date. For example, the database by Epocrates
provides physicians and other prescribers with information about which products appear on the formularies of various plans
under the Medicare Modernization Act (Part D). This information was available as soon as Part D took effect. That is, it was
ready in a timely manner for practitioners who needed help right away.