Think like a doctor

April 1, 2005
Michael Kessler
Michael Kessler

Michael Kessler is a physician and is president and CEO of the Atlanta-based Medical Communications Center. He conducts beginning, intermediate and advanced sales training workshops for the pharmaceutical, medical product and device industries. He can be reached at or (404) 257-1251.

Pam Bailey Marinko

Pam Bailey Marinko is director of professional development for Wilmington, NC-based aaiPharma Inc. She is also a co-founder of the Atlanta Medical and Pharmaceutical Representative's Association and a member of the Pharmaceutical Representative editorial advisory board.

Pharmaceutical Representative

Getting into the M.D. mind-set

Youhear it every day in the training room.

"How can I get my doctors to change what they're doing?"

"What do I have to do to make these doctors understand that my productis the best choice?"

"I'd love to present more clinical information, but when is there timeto do it?"

The job of a sales trainer isn't getting any easier, and in fact, it'sgetting harder to teach representatives how to influence doctors'clinical behaviors and prescribing habits since those behaviors areconstantly evolving. Hard to believe? Look at the following facts aboutthe practice of medicine:

* Doctors must make complex and unique clinical decisions every day tosolve their patients' problems.

* Decisions made by doctors involve a dynamic combination of scientificand anecdotal data gathered every day from publications, patients andcolleagues.

* Clinical behaviors, and therefore prescribing habits, evolve eachtime a decision is made to solve a patient's problem.

* Doctors have a specific algorithm they use each time they confront apatient problem.

* They all use the same algorithm to make these decisions.

So what have we been waiting for? If we know the specific algorithmthey all use to make clinical decisions, shouldn't we use it to discussthe process of care and treatment approaches? Yes! It's not as hard asyou think to help trainees master this process.

What doctors want from reps

A marketing study published in the May 2003 issue of Pharmaceutical Executive magazineshowed that doctors want unbiased scientific information and clinicalcomparisons so they can weigh the evidence and decide for themselves.

In a 1999 issue of the Journal ofContinuing Education in Health Professions, Henry Slotnickdocumented that a "doctor's interaction with a sales professionalshould be less a sales event and more of an opportunity for the doctorto exercise his/her abilities as a learner."

Research proves that learning creates and changes both clinicalbehavior and prescribing habits. For doctors, most learning ispractice-based, and they view their practice and patient experiences asopportunities for learning.

They also view these experiences as a way to increase the number ofdata points that form their diagnostic and prescribing knowledge base.Learning is set in motion by their practice and patient needs.

What is the M.D.'s mind-set?

Here's the scoop. During medical school, all doctors learn ananalytical, step-by-step process to make decisions that solve theclinical problems they see on a daily basis. This process relies onscientific information gathered from many sources and is consistentlyused to:

* Diagnose, treat and manage.

* Evaluate the clinical literature.

* Assess new and existing diagnostic and treatment options.

The scientific method that is taught to medical students is complex andconsists of multiple steps. While this method is buried in nearly everybeginning medical textbook and in several other curricula, we havefound that representatives want a distilled version of this method toadopt as a best practice. We have trained various groups ofprofessional sales representatives on this process (which we call the"M.D. Mind-set"); it is composed of four simple and distinct steps thatare both enduring and repeatable. The steps are represented by theacronym IDEA, which stands for: identification, discovery,evaluation/decision and action.

To understand how this process works in clinical practice, considerthis scenario.

One of your target doctors hasmentioned that something a patient said to her raised a question in hermind about the disease state that relates to your product. She hasdecided that she needs additional information about this problem so shecan adequately address the patient's concern (identification).

You realize this is the primarymessage your promotional materials have been illustrating over the pastseveral months, but since you are rarely able to engage in meaningfuldialogue with this doctor, it's possible that she hasn't seen yourinformation. It's also possible that this doctor considers the datacontained in visual aids and advertisements biased, since it may havebeen taken out of context and may not provide the doctor with theinformation she needs.

She tells you that she has gatheredinformation from peer-reviewed journals and from her colleagues(discovery) and has evaluated it in terms of how it relates to herexperience and this specific patient (evaluation). The physician tellsyou that only when she feels she has all the information she needs willshe take action by trying your product in this specific patient(action).

In this example, the doctor walked you through her problem-solvingprocess. But since this process occurs continuously throughout eachday, you won't often have the opportunity to review physicians' actionsso carefully.

By taking the time to learn the elements of the four-step process thatdoctors use day-in and day-out, your trainees can make gaining ongoingphysical and mental access to doctors not only possible, but alsoconsiderably more likely. Consequently, they will be more likely toinfluence these physicians' clinical behaviors and prescribing habits,since the representatives will be in sync with each doctor'sproblem-solving process.

By understanding how doctors learn and solve problems, as well asdetermining which stage of the process each doctor is considering,representatives can provide the most relevant information at the mostappropriate time and in the most effective manner. This allows them tomaximize their call time by moving the doctors more efficiently throughthe education and acceptance process. In turn, this helpsrepresentatives influence more doctors' clinical behaviors andprescribing habits with fewer, more constructive calls.

How it will impact your results

Sales professionals can improve their sales results by shifting theirperspectives on changing a doctor's clinical behaviors, which areconstantly evolving. These changes take place when physicians learnabout solutions to the diagnostic and treatment problems they encounterevery day. What's more, doctors want to be active participants in theirlearning. If the information a representative has to offer is presentedto the physician as an opportunity for learning and improving theproblem-solving process, everyone benefits -- the doctor, the patientsand the representative.

It is vital that sales professionals become involved in the processdoctors must go through in order to change their clinical behaviors andprescribing habits. By training representatives to view time with adoctor as a part of a larger educational process, you make it possiblefor them to contribute to that learning process and meet their goalsmore quickly. Scientific information is more effective when used as aneducational tool rather than a sales tool.

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