Ten Minutes to Connect

Pharmaceutical Executive

Pharmaceutical Executive, Pharmaceutical Executive-04-01-2009, Volume 0, Issue 0

How one conversation between a woman and her physician can make or break a brand

Marketing preparation for a brand takes years. The fate of a brand, however, can be determined in as few as 10 minutes. Today, that is the average length of the office visit between patient and physician. When that patient or caregiver is a woman, the 10-minute interaction becomes even trickier. Because of subtleties in how women communicate, brand potential can be affected by as little as a look, a word, or one question left unasked.

Marcee Nelson

What women are looking for is less consultation and more conversation. This is especially true for non-life-threatening conditions such as menopause or contraception, or manageable conditions such as migraines and chronic pain. The new ideal in health management is physician-as-partner. But that doesn't lend itself well to a few short minutes in the doctor's office.

Is the conversation dynamic impacted by the fact that there are more female physicians in women's health? The common belief is that women prefer female physicians, but a recent "She Says" national survey of 1,200 women conducted by Marketing Technology Solutions indicated that the preference is less about gender and more about the qualities commonly associated with women: empathy, listening, partnership. If women leave a physician's office without experiencing those qualities, they leave feeling uncared for, regardless of their physician's gender.

With pressure from managed care and the resulting demands on medical practices, healthcare professionals are torn between a desire to give the best care possible and their daily race against the clock. Meanwhile, women's expectations are increasing. Medical knowledge is becoming a commodity for patients, caregivers, and consumers because information about any drug or disease state is just a Google search away. Women search health information more than any other topic online. The digital age has created an instant gratification factor that extends even to the doctor's office.

The Conversation Destination

Pink Tank is a full-service consultancy specializing in marketing to women. The company conducts qualitative research on behalf of clients, including focus groups and other research done by brand counselors with expertise in psychology, patient advocacy, gender, and cultural studies, as well as extensive experience in marketing to leading consumer and healthcare brands.

In recent qualitative research on the subject of menopause therapy, an OB/GYN said, "A successful conversation is when we both come to the same conclusion." In the same research a patient answered, "When I'm involved in the decision." Physicians want to feel they are giving the best care possible, and women want to feel cared about. The key is that they both want to agree. The contribution a brand can make to this insight is twofold: First, it helps both physician and patient walk into their visit prepared to agree, and secondly, it acts as a conversation catalyst to facilitate agreement, so both leave feeling more satisfied.

Every conversation has two sides; each side is equally important to success because conversation can be derailed on either side. Every time a doctor says "I don't think so," or a woman leaves with unspoken concerns or unanswered questions, an opportunity evaporates. To help each side prepare to agree means looking at the conversation as a destination in the marketing communication plan, rather than just another channel. On each side the beliefs that drive behavior must be addressed. To assume those beliefs are simply about therapy is a limited, product-centric view. The beliefs that need to change could be how the physician or patient feels about the disease itself, about each other, or even about themselves. Taken from real-world successes, below are some guidelines on becoming a conversation catalyst—and what to avoid—in the physician/patient dialogue.

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:

1) 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.

2) 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."

3) 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.

4) 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.

5) 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:

1) 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.

2) 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 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.

3) 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.

4) 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.

5) 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 mlnelson@gsw-w.com