Five Conversation Breakers
There are a number of sensitive topics that must be avoided in order for physicians to take best advantage of the 10 minutes
they have to reach their female patients:
Embarrassing or stigmatized conditions. Sensitive topics like facial hair, sexual dysfunction, urinary incontinence, or moodiness
cannot be brought up. These are what physicians refer to as "door handle subjects" (mentioned just as the doctor is leaving
and feels most time-pressed) or "Kleenex box topics" (that cause women to become emotional). In qualitative research, these
are situations doctors admittedly try to avoid.
Lack of validation. As one physician confessed in an online focus group, "I'd rather have anything behind the door than a
menopausal woman." Women often feel unsure of themselves when facing a healthcare professional. For example, in a patient/physician
dialogue focus group for a vasomotor treatment, a woman complained emphatically to other women about the severity and impact
of her hot flashes. Later a physician leaned toward her assertively and asked, "Is it really that bad?" She backed away and
replied, "No, I guess not."
Caregiver syndrome. While they readily speak up on behalf of others, women can often be stoic about their own health and tend
to minimize their own problems. In recent qualitative research on rheumatoid arthritis (RA) treatments, women confessed that
they didn't disclose the extent of their symptoms because that meant they would need more serious treatment. Doctors felt
they should be doing more, but allowed patients to lead the way. More effective therapy didn't even enter into the conversation.
Auto-pilot. Patients have an average of 20 seconds to speak before physicians interrupt them. Low-priority or low-interest
subjects are often treated by rote, and get a doctor response that is simply automatic.
Stereotypical conditions. In situations like obesity or diabetes, or in cases where a higher level of patient commitment is
required, physician bias can stagnate potential. In qualitative research on osteoporosis, it was revealed that doctors were
visually profiling women who they thought would not accept a self-injected treatment based on how fragile the woman looked.
That option wasn't raised often with those patients. When it was, it was framed in a way that suggested non-recommendation
such as, "Well there is another option, but it's an injection."
Five Conversation Makers
Likewise, there are certain subjects physicians can raise in order to facilitate communication in the crucial 10-minute interval
they have with female patients. These include:
Find the issue magnifiers (for both physician and patient) that will take their mindsets from "why" to "why not" before the
conversation occurs. When the issue value is understood and addressed ahead of time, the conversation can happen in shorthand.
For Gardasil, Merck found the issue in connecting HPV to cervical cancer. Making sure the next generation of women has less
cervical cancer is something mothers will support, while getting a 10-year-old daughter vaccinated for a sexually transmitted
disease seems too much.
Give women the support to speak up. Overcoming lack of validation (this is a real condition) or creating normalization ("other
women have what I have") is key to getting women to open up. Connecting women with each other can help accomplish both. Wyeth
does that with
http://www.knowmenopause.com/, where women can hear others talk about their menopause symptoms and strategies. They also offer symptom-assessment tools
on the site that can speed up the discussion.
Create a commonly own-able language. Allergan used public relations as a way to teach women to say, "I want to erase my 11's"
for Botox. Years ago, Depo-Provera understood the need for the right language to talk with teens about contraception, and
actually had a positive impact on the number of teenage pregnancies in the US. Today, Yaz has carved out a unique niche "beyond
birth control" with its own vocabulary.
Make sure the "one question" gets asked. By getting physicians to ask frequent sufferers, "How do you feel between migraines"
instead of just "How frequent are your migraines?" Topamax was able to redefine prevention, from taking a pill at migraine
onset to taking medication daily to break the cycle of pain and dread. The same question was used in DTC to help women self-identify
and speak up to their physicians.
Help doctors to be better listeners. Quality-of-life impact can sometimes be hard for physicians to visualize, especially
when they need to focus on life-threatening issues in the few short minutes they have. In urinary incontinence focus groups,
doctor sentiment was, "No one has ever died from wetting her pants." But in fact many women are dying. A brand can help physicians
know ahead of time what women are feeling and offer conversation tools that bring a sense of empathy, listening, and partnership,
without adding a lot of extra time to the office visit.
Impacting both sides of the conversation doesn't automatically require a big budget. Some of the examples above worked in
a more targeted way, without mass media through advocacy groups, online communities, patient materials, and PR.
After the 10 short minutes they spend together, the physician wants to walk out feeling like the best care was given, and
the patient wants to leave feeling more cared for. The bottom line: Marketers who focus their efforts on simply getting doctors
to agree to the benefits of a brand are missing half the answer, because for many women's health issues, the agreement that
counts is the one that happens between women and the physicians who treat them.
Marcee Nelson is founder and president of Pink Tank, a division of GSW Worldwide specializing in women and health. She can be reached at