The doctor will not see you now

In my last post I asked for reader feedback. Comments I received included that the content is fresh and relevant, that it makes a nice change from fire-fighting and that the topic range is appealing. If you found the time to answer, thank you, if not but you do have thoughts on the content I’d love to hear your opinion.

On another note, the sun has finally come out and summer is here. Many of you will be off on vacation soon. I hope you have a wonderful time whatever you are up to.

Today’s topics:

  • The doctor will not see you now
  • Beware the lure of the pharma friendly doctor
  • Nurses protest the use of AI in healthcare 
  • Leadership: How to ace difficult conversations

The doctor will not see you now – reimagining customer engagement
Pharmaceutical industry employees often discuss how best to provide value to healthcare professional customers (HCPs). The belief is widespread that the industry is the best source of uptodate knowledge on products. In line with customer preference, information is provided in many different formats: on demand, via websites and at conferences, but also in face-to-face engagements with MSLs, sales representatives and other pharma company employees.
Naturally, while I concur that the company that developed and markets a product knows most about it, and is best placed to provide information, it is important to not only understand today’s healthcare providers reality and their needs, but also to flex to customer’ preference regarding how they access information, which may, and this is important,  include never or only very rarely seeing a company representative. 
As a physician I remember the sales representatives in the hospital corridors. They were often impeccably turned out relaxed looking young women whose day-to-day life looked to be light years removed from my own harried running up and down hospital corridors. My schedule was intense and felt non-stop. Revolving as it did around patient care, family members, organising long-term care, social services, scheduling rehabilitation, negotiating with payers, negotiating with nurses, reviewing the results of the examinations I had scheduled, and yes, also discussing treatment options and prescribing medicines. 
Days were long and tiring and invariably seemed too short. This was my reality as a clinician years ago. Unfortunately, the situation has not improved. In many countries healthcare systems struggle to retain HCPs and some, such as the NHS, haemorrhage doctors at an alarming rate. The doctors that remain are under increasing pressure to be ever more efficient and hence have less discretionary time and many patients experience issues accessing doctors. So, if you represent the pharmaceutical industry, unless you have exciting new scientific data to share, are launching a new product, or want to discuss research and development or you have an excellent existing relationship it will likely be very hard to get time with a physician.
But despair not, while many doctors may no longer make time to meet a company representative, most are still interested by the information provided by the industry. This is where the ability to flex to customer needs is important, and this in turn, depends on the following: understanding doctors’ realities, the type of information they need, the format that works best for them, when and how they want to access it, and whether or not they ever want to meet someone face to face.

 In turn, this means, that an evolution of measuring successful engagement by pharma company employees beyond number of contacts achieved, is needed.
Key takeaway: Flex your information provision model to individual customer preference, reality and need and do not punish your customer facing individuals for not making their call numbers. Instead change how you assess engagement. 

Beware the lure of the pharma friendly doctor
There are posts on social media about prioritising engagements with so-called “pharma-friendly” doctors over those who are not “pharma-friendly“.
One MSL wrote that she is more efficient if she engages with health care professionals (HCPs) who actually want to talk to her. This of course makes sense and is very reasonable. However, there is a caveat: focusing only on doctors who are willing to see you personally means you engage with a non-representative subset of all HCPs, which is like enrolling only certain individuals in a clinical trial. It is easier, but not representative, and consequently you might struggle when you want to use the insights you have garnered, to address the entire marketplace. 
Of course, there is no point trying to force doctors to engage in personal relationships who do not want to be thus engaged. Instead, it makes sense to not only stratify doctors by their importance for the company, but also by their ideal engagement styles.
I believe, that given the right partner, and the right approach, most physicians will engage with a pharma company representative, although their drivers may be very different. For example, a physician friend of mine will see a representative, if she has a good relationship with them, or if they have such interesting data that she wants to hear about it quickly. A fellow physician, who works for pharma, told me he would regularly engage with those doctors who were deemed not “pharma-friendly” because he engaged critically, scientifically, and openly and was able to explore topics to a great level of depth which was appreciated. Some doctors may want information on demand, via the web, or via call service to an expert. Some may prefer to be given access to information they have signed up for, for example Sanofi provides subscribed HCPs with Medical Information news via messenger people (Link).
In general, as people become ever more hesitant to give appointments in advance, and appointments are prone to change at the last minute, it is worth considering how to give HCPs tailored access to the information they desire.
This necessitates developing a new way of measuring customer engagement. Naturally, it is harder than having reps meet visit targets and sales targets but as the world changes so should how we work.
Key takeaways: 
 1) Visit only pharma friendly HCPs at your peril as you risk not understanding the markets 2) And tailor the access to your materials to different stakeholder needs and preferences.

Nurses protest the use of AI in healthcare
There is widespread hope that AI will support healthcare professionals to work more efficiently and effectively.
One of the largest not-for-profit US healthcare providers Kaiser Permanente, which serves 12.6 million members, at 40 hospitals and 616 medical offices and is staffed by 24605 physicians and 73618 nurses (link) has embraced AI and has been putting the technology to the test for several years.  
In fact, Kaiser Permanente received an award in 2021 for their Advance Alert Monitor (AAM) programme, an early detection system which supports clinicians by predicting when patients are at risk of clinical deterioration (Advance Alert Monitor Kaiser Permanente Website 19.4.2022), find a discussion on the topic at the AMA website Link. Kaiser Permanente has also rolled out an NLP model to help manage physician email inboxes (JAMA April 4, 2024, Content of patient electronic messages to physicians) and has rolled out an Augmented Intelligence in Medicine and Healthcare initiative   which provides grants to selected organisations to advance the use of AI in medicine (Link).
With publications on the topic in the New England Medical Journal, and the Journal of the American Medical Association and recognition in the form of awards, it would appear that all is going well. However, the roll-out of AI in healthcare is the subject of protests by Kaiser Permanente staff. Family medicine nurse Michelle Gutierrez Vo is quoted as having said  “there are some uses of AI that are not acceptable” in the San Francisco Standard (The San Francisco Standard”). The issue is that AI is judged to be being implemented not to support nurses and doctors but mainly to cut costs and boost profits. In order to ensure that AI meets the needs of clinical staff the demonstrating nurses demand to be involved in development and deployment decisions around AI in healthcare.
One website that shares slogans seen at the demonstrations listed the following “Patients are not algorithms – trust nurses, not AI” (Link).
What is interesting in the above is the contrast between how the groups report the success of AI implementation in clinical practice. One group considers it a success, saying “We believe that AI may be able to help our physicians and employees, and enhance our members’ experience (Link) while the nurses, feel differently “There is nothing inevitable about AI’s advancement into healthcare. No patient should be a guinea pig and no nurse should be replaced by a robot” Cathy Kennedy, RN, Kaiser Permanente nurse and a California Nurses Association co-president (to National Nurses United) (Source Link)

Beyond the different perception of value add between employer and employees, it is interesting to note that trust figures hugely in the protest. Protest slogans highlight a lack of trust – and indeed mistrust of AI and its potential to improve healthcare outcomes.
The subject matter is complex, and it is impossible for me to discuss the positions above with any authority. However, the topic is interesting because it highlights the use of AI in healthcare, shows the promise, shows the risks of deployment, and the risk of people believing it is about profit over people. What it also highlights is that unless stakeholders are involved in every stage of a project be that AI, or anything, else from design to deployment, they are likely to mistrust the technology and the programme which can negatively impact success across the board.
Key takeaway:
Kaiser Permante nurses faced with AI in their work deem it unfit for purpose. Any new technology that is implemented into an operative setting without engagement of frontline stakeholders is likely to fail. Therefore, opt for sustainability over speed, move slowly and with sufficient stakeholder engagement from those at the pointy end of the business.

Leadership: How to ace difficult conversations

In the past weeks I have had several discussions with experienced professionals. All of them about how best to manage difficult conversations at work.

Each individual had scheduled a conversation with their manager and was considering how best to broach their concerns. All of them had a specific reason for the meeting: for one it was an elusive promotion, for another the mismatch of a job description with the actual job, and for a third addressing underperformance with an employee that was protected by the manager.

However, each individual I spoke to told me they planned to use the meeting with their manager to discuss not only their key topic, but also any other issues and business related topics that were related to their job.

I recommended they focus on the key topic and postpone all others for three reasons:

  • The first is that most people have a limited attention span.
  • The second is that if you know a conversation will be a challenge it is tempting to lead it with non-contentious topics only to run out of time for the actual topic that is important to you.
  • The third isthat meetings are often cut short and you want to ensure you address your topic as early as possible.

So, when you have a difficult discussion coming up, I’d recommend you consider what your ideal outcome is, ask colleagues for their thoughts and experience, if relevant, and anticipate your manager’s responses. Focus on understanding your manager’s point of view. By all means have a variety of potential solutions prepared before you go into the meeting just make sure to introduce them judiciously and to not to force them on others.

Above all don’t demand that your manager agrees with your opinions, immediately delivers a solution for you or accepts without question your proposed solution. Instead consider asking some of the following questions “What is your position? Does what I have said make sense? Is this something we can address short to medium term? What would I need to do to change the situation? What else needs to happen? And what timelines might I be looking at?” Always aim to find a solution together because that makes you a team looking to find a solution instead of two individuals with potentially opposing opinions.

If you have an upcoming critical conversation that you are nervous about and would like to prepare with an executive coach I’d be happy to support you.

Key takeaway: If you have a critical conversation coming up focus on one issue and collaborate when looking for the solution.

I hope my blog provides you with useful insights. If you need help with a project or with managing a dysfunctional team, or a functional team in a dysfunctional organisation, give me a call to see how I can help. You can find out what clients say about working with me here: Link.

My very best wishes

Isabelle C. Widmer MD