Patients in control	October 2008

Med Ad News spoke with Alfred O’Neill, senior VP, group director, Ryan TrueHealth (ryantruehealth.com), to learn more about how personalized communications can help improve the physician/patient dialogue.

Despite differences in chronic conditions, all patients refer to the same trusted information sources when making healthcare decisions. Fielded among 25,000 patients with at least one chronic condition, Ryan TrueHealth’s Patient Power healthcare study found that healthcare professionals and experts are still the most trusted information source for patients. Peers, spouses, and friends, however, are the second-most trusted source for healthcare decision-making. In addition, advocates play a highly influential role in motivating other patients because they are natural information gatherers and disseminate what they learn.

The study found that authentic communications with patients helps marketers meet patients’ needs for trust, but while they look for authenticity, spiritual beliefs are an important source in patient decision-making. In addition, patients want information that is personalized. Marketers who deliver the right information to the right customer at the right time create opportunities for ongoing communications.

Q&A with Alfred O’Neill

Med Ad News: Are there problems with the way physicians and patients communicate?

Alfred O’Neill: Our research and other research, as well as the interviews that we've done, all show the same thing is happening, which is they’re talking past each other. The patient has one agenda and one set of needs and the doctor has another agenda and a different set of needs. The patient comes in armed with downloads from the Internet, doctor guides from different product sites, WebMD descriptions, and having talked to friends. And the doctor, if he had given them a new diagnosis, has a script in his head and they have a checklist that they have to get done in the 10 minutes they have with that patient. So, they already start in an almost non-listening position. The doctor is waiting for the patient to finish because they have serious things they have to do, and because of managed care they have to move on to the next person. It’s no fault of the doctor and no fault of the patient. This is driven by the changing economics of managed care. So, what happens is patients often leave feeling that the doctor did not listen and just pushed the drug.

[The patient is left wondering,] well I'm about to go on this drug, what are the side effects? Will my insurance pay for this? What will this do to my relationships, depending on the condition? So many questions that should be resolved with the doctor are not, and thus as all good humans do we walk away with doubts in our head, and those doubts take root as they grow into bad compliance and persistence, or adherence as we all like to call it now.

Med Ad News: What can pharma marketers and their advertising agencies or relationship marketing companies do to serve patients and doctors in this environment and what are they doing?

Alfred O’Neill: I hate to say, part of the answer depends on the condition. This comes down frankly to the brands, the brand managers, and things like that. You run into some brand managers who are completely professionally oriented and don't think the patient needs much. Just put together some brochures and put them out there. Then there are the brand managers and people in pharma who say we need to understand the patient and address their needs and answer them.

So, generally what they need to do is understand that DTC is a big giant fishnet, and it doesn't answer any questions. It just drives them to the doctor with lots of questions. What agencies and clients could do is understand our patients at a real behavioral attitudinal basis. So lets say for a symptomatic disease like cardiovascular hypertension — we just finished doing a lot of consulting with a major pharma company about what they should do as an entire organization to keep more of their patients on their hypertension medicine and lower their blood pressure. The first thing they found out was they were using the word hypertension everywhere in their communication and then through research found out that the patient didn't know that hypertension meant high blood pressure. The patients had no idea.

The first communication was a complete failure, so what they've done is understood that the patient does not exist alone. It exists with a world of influences around them: the doctor, the nurse, the pharmacist, and now even our own research shows that after you go to your doctor, people go to their peers, friends, and family next for information. They're not medical experts. They're going to tell them their own personal experience or what they've heard anecdotally. The big challenge is that pharma marketers need to get command as best as possible of all those influencers and understand the patient at an attitudinal behavioral level.

Med Ad News: Are personalized materials the most benefit to patients?

Alfred O’Neill: Who among us likes one size fits all? None of us, whether it's going to a clothes store or dealing with my health. Patients are consumers, so they may make choices based on overall behavior patterns that they established. Who spoke to me, who spoke to my needs, and if my doctor believes that this is a brand which really gives me the most support, the best information, there's really a fair chance that doctor is going to favor that brand over others.

Procter & Gamble has decided they'll hand over control of their products and how they're communicated to the consumer themselves. That is a seminal shift. That is a huge shift in marketing communications, and that's consumerism. If I'm getting that as a consumer, why wouldn't I expect that of my other brands I spend money on — especially all the medicines I spend money on. Pharma is just barely understanding that the consumer is in control. They still think that it's about the doctor and the rep and that my drug has greater efficacy. It's not.

Ethnographic research should be channeled back to being used in communications because if you think about it, ethnography is actually our most personalized experience of a patient. What's amazing to me is that pharma companies are just discovering that that's a great way to understand the patient. Focus groups are false environments. The event is affected by the atmosphere of the event itself, whereas in ethnography, this is how I live, this is where I live, this is what I do. It's just how I live with my condition, and this is how I live with my treatments.

One of our clients we're trying to convince to put money into creating a series of reality TV chapters around two different patients that you could watch as chapters online. That's nothing more than an ethnography. That's an ethnography used to personalize experience because everyone wants to know after their doctor what somebody like them is going through. Are you like me? Do you understand this? I need some information.

Ethnographies are almost like part of the secret sauce that is missing from the patient communications, let alone the research. But the patient communications bring it to life in a way that basically says, this brand understands me, and that's actually going back to Procter & Gamble. That's why they've given over control of their product and their marketing to the moms and the females who make the purchase decisions for the most part. Because they realize that they're in control and they need to get out of the way. Good mature pharma brands are going to start to understand that letting a patient advocate is only going to help convince others of why they should try this treatment or why they should stay on it.