by Dr. Sebastian Barnutz and Dr. Wiebke Gronemeyer
Don’t ask for advice. Explore physicians’ considerations instead.
Physicians make treatment decisions out of a desire to create the best outcomes for patients. But how they make those decisions is profoundly shaped by the beliefs, needs, and priorities of the institutions, colleagues, and peers with whom they work.
With so many underlying forces at play — many of them unspoken or even invisible to the physicians themselves — simply asking for advice will never do. Instead, pharmaceutical and life sciences companies seeking expert input must design their questioning so that the subtle forces shaping physicians’ actions become apparent in their answers. Otherwise, the insights gained won’t fit into the puzzle of stakeholder cooperation, global market forces, and regulatory considerations that make up today’s complex landscape shaping the development of drugs and treatments.
Companies’ interactions with these physicians must aim for understanding their treatment decisions and daily routines through deconstructing the rationales behind these decisions. We have found that the best way to do so is through extrapolation: Start with a concrete patient scenario. Ask physicians to explain their decision-making in that scenario. Examine their answers: What aspects are due to medical considerations? To organizational considerations? To economic considerations? Then ask: What can we extrapolate from these findings?
The Forces Shaping Physicians’ Decision-Making
Only after fully understanding these underlying considerations can we draw accurate conclusions from our investigations. Differentiating between these three perspectives is key:
The Medical Perspective
Physicians’ medical decisions are driven by their interpretations of available data. These interpretations are affected by the data at hand, the experiences of the physician, and an array of dogmas and beliefs that reflect medical culture more than they do data-based truths. (For example, doctors often default to the position that chemotherapy kicks in faster than almost any other oncology treatment, even though research shows some antibody treatments can be quicker.) When communicating with doctors, it is worth asking yourself: With which conviction is data used to justify a therapy decision? How much of the data interpretation is colored by other belief systems, experiences, or considerations?
The Organizational Setting
The organizational setting has a huge impact on a physician’s interpretation of a given treatment. For example, if an adverse reaction to treatment may require fast hospitalization, a physician who routinely collaborates with a nearby hospital will be more likely to decide in favor of that treatment. Similar questions arise when a specific diagnostic procedure is required before diagnosis or treatment. If interdisciplinary cooperation is required, physicians may consider to what extent this cooperation is already in place and working. Anyone involved in strategic planning for such treatment must discover: Do the established routines cover all necessary steps from diagnosis to follow-up? If not, how could necessary steps from diagnosis to follow-up be made routine? Does this new treatment method in any way jeopardize the effectiveness of existing daily routines?
Economic Forces
Health care systems and their reimbursement structures always contain incentives for certain treatments over others. It is essential to uncover these and understand how they affect treatment decisions: Will necessary diagnostics be reimbursed? Which treatment comes with the best cost-benefit ratio for the medical unit? Do they have to give up on one treatment — and its accompanying revenue stream — to provide patients with a new treatment (as has happened for some treatment centers that must transfer patients elsewhere for gene therapy)? Physicians are often more comfortable discussing medical considerations, but fiscal considerations stemming from treatment business models must be uncovered as well.
Foreseeing the changes medical innovations will bring for the workflow of physicians and proactively articulating them may encourage stakeholders to re-evaluate their stance. This, in turn, will help to extrapolate strategic options that do not bounce off treatment realities but can include and potentially alter them.