Getting Doctors to Spill Their Guts
Innovative Ways to Dig Deeper
by
Patricia Sabena & Nicole Sabena Feagin
Sabena Qualitative Research Services
Westport, Connecticut, USA
Why are doctors so difficult
to interview deeply?
• Arrogant, egotistical, sarcastic
• Extremely literal, left-brained
• Increasingly busy, overburdened
• Increasingly resentful about $, HMOs
• Limited by training, ‘book’ medicine
• Fall back on comfort, habit, sales reps
What is the background
of this paper?
• Straightforward qualitative research
projects among physicians:
• Often come away without much
conviction that they have gotten to the
bottom of what drives doctors
• Especially in their treatment of the signs
and symptoms of various disease states
What were the disheartening
hypotheses so far?
• Physicians are not very emotionally
involved in treating early warnings of
cardiovascular risks because conditions
tend to be asymptomatic and patients
resist lifestyle changes and medications
for:
• Diabetes
• High cholesterol
• High blood pressure
What were the disheartening
hypotheses so far?
• Despite recent medical findings and
authoritative guidelines emphasizing the
benefits of aggressive early treatment in
preventing organ damage, morbidity
and mortality, physicians:
• Still proceeding very overcautiously
• Not spending enough time with patients
• Not emphasizing importance of medication
How do you switch the set-up
to get doctors to spill their guts?
• When each interview begins, tell doctors:
• “This will be unlike what you may have
experienced in previous research”
• “Take a leap of faith,” “tap into your creative side”
• “Don’t over think,” “just get into the moment”
• Call doctors by their first names only,
launch each interview immediately into
projective techniques to avoid groupthink
or physicianspeak
What projective techniques
do we particularly recommend?
• Scrap Art: turned into collages later
• Heart Maps: rank order their priorities
• Memory Storytelling: share their experiences
• Sentence Completions: metaphors/analogies
• Psychodrawings: typical user by class of drug
• Tarot Cards: storytelling about archetypes
Magazine Scrap Art
yields us 23 different collages!
• Each doctor uses non-medical magazines to clip
out and discuss pictures, words and phrases
symbolizing their treatment of cardiovascular
disease. (NOTE: These were later turned into themed collages by
the interviewers, although each is represented here by a single image for
proprietary reasons.)
• Even the most basic themes manage to
dimensionalize factors doctors consider in
treatment:
• Lifestyle risk factors (diet, obesity, alcohol, tobacco,
stress)
• Better choices (good diet, weight control, fitness,
exercise)
• Population sensitivities (African-Americans, patient as
individuals, impotence concerns)
Magazine Scrap Art
yields us 23 different collages!
• The role of time (asymptomatic hidden
killer, time bomb, long-term damage)
Magazine Scrap Art
yields us 23 different collages!
• Patient resistance (surprise, denial,
vulnerability, non-compliance)
Magazine Scrap Art
yields us 23 different collages!
• Patient motivations (damage control,
fighting the battle)
Magazine Scrap Art
yields us 23 different collages!
• Treatment strategies (simple,
frustrating, confusing, innovative)
Magazine Scrap Art
yields us 23 different collages!
• Patient outcomes (victory, longevity,
happiness)
Magazine Scrap Art
yields us 23 different collages!
• Physician engagement (teamwork,
teaching role, adventure, leadership)
How does the Heart Map work?
• Give a sheet of paper showing a red
heart, and ask each physician to:
• write down spatially and rank order by
number
• disease states, emotionally, closest to
and farthest from his/her own heart
Heart Map yields revelations
contradicting earlier hypotheses!
• Our Internists, Family Practitioners
and Cardiologists consistently rank
diabetes, high cholesterol and high
blood pressure as the “big three”
they most like to treat:
• Today’s newest Rx’s make a difference
• These conditions are so ubiquitous
• These conditions are so dangerous
Their “big three”:
Diabetes
High cholesterol
High blood pressure
Too minor, less engagement,
less clear means to achieve
results: acne, psoriasis,
eczema, urinary infection,
colds and sinusitis, gastritis,
acid reflux, arthritis,
migraines, obesity, smoking
cessation
Too difficult, unqualified,
leaves them out of their
depth without being able to
help: Alzheimer’s, MS,
AIDS, Parkinson’s, cancer,
fibromyalgia, psychological
disorders, substance abuse
What happens next with
Memory Storytelling?
• Completing the Scrap Art exercise and
the Heart Map stir up or rekindle
memories of good and bad treatment
experiences
• In sharp contrast to how they struggle
or refuse to answer this same good/
bad treatment experience question by
rescreener in the waiting room,
doctors immediately and emotionally
come up with remarkably detailed
recollections
“A 50-year-old white female came to my office
complaining of mild headache, a new patient. I
suspected full metabolic syndrome because of her
obesity and family history, and drew blood for tests for
diabetes and hyperlipidemia. Her blood pressure was
very high, 210/110. I began with combination therapy of
ACEI and CCB and told her to come back in a few days.
Her blood pressure went down to 140/90 and she was
not complaining any more of a headache. I felt the
combination therapy was the best suited, a little bit
faster. The blood tests came back rather high in sugar
and I felt really elated to have caught her Type 2
diabetes so early and to be able to counsel her about
lifestyle changes and diet. I felt I had that supernatural
power that I was able to help this lady (gestures
heavenward to a higher power).”
Cardiologist, California
“My worst memory is a 52-year-old African-American
male with a long history of Type 2 diabetes, high
cholesterol and hypertension. He had a stroke about
eight years prior. He’s presently on about six drugs,
including Clonidine, and fairly compliant. A few months
ago he showed up at the emergency room with an
intracerebral hemorrhage. He didn’t suffer a lot of
sequelae from the stroke, but he still has some aphasia.
Every time he comes into the office, I’m still worried
about his cholesterol and his diabetes, and I’m scared
to take his blood pressure.”
Internist, North Carolina
Now doctors come up with dozens of
different vivid Metaphors or Analogies
• In this thoughtful frame-of-mind after
their memory-based storytelling, give
physicians Sentence Completion
exercises asking them to come up with
Analogies or Metaphors:
• Treating diabetes (high cholesterol, high
blood pressure, congestive heart failure)
is like…
Now doctors come up with dozens of
different vivid Metaphors or Analogies*
• Encourage them to “borrow” Metaphors
and Analogies by posting examples of
“different worlds” on a flip chart:
•
•
•
•
•
Sports, politics
TV, movies
Fairy tales, games
Animals, cars
Food, beverages, etc.
• *The metaphors and analogies from this research were so rich and so
useful for the client that we are unable to disclose them.
What can Psychodrawings
tell about doctors’ prescribing habits?
• The most typical candidate for each
particular class of drug (first line):
• Body type, race, gender, clothing
• First name, age, marital/ family status
• Relevant health stats, co-morbidities
• Personality/ lifestyle adjectives, objects
• Sentence that captures patient’s attitude
Here’s a typical drawing by a doctor
of an ARB user!
Here’s a typical drawing by a doctor
of an ACE Inhibitor user!
Here’s a typical drawing by a doctor
of a Beta Blocker user!
How can Tarot Cards serve as
stimuli for understanding archetypes?
• Using 42 cards of the Tarot, ask doctors to pick a
few cards that symbolize their feelings, beliefs and
values about being a doctor in the practice of
medicine to treat specific disease states or risks
• Their individual choices--and the stories they then
tell about the cards they pick--reveal archetypes of
their engagement, their roles, their doubts and
frustrations, and their rewards
• And yield many surprising outcomes that bust
myths about today’s cynical stereotypes of
physicians!
Much much less about
power and arrogance
• Very very few choose “powerful” or
despotic “rulers”
Much much more about the
magic of healing
• Many identify with “magic” by “waving
a wand,” using a “bag of tricks” or
giving a “potion” of drugs
Much more about
saving and rescuing patients
• Many talk about feeling like the “knight
in shining armor” or the “warrior”
Much more doubts about
their own judgment and choices
• Many concede “loneliness,” “challenge”
and “frustration” in their decisions
Much more acknowledgement
about the role of luck
• Some reveal their “insecurities” about
the “hit or miss” of treatment
Considerable frustration with patients
in denial or non-compliance
• They feel critical of “foolish” patients
who ignore the dire consequences
Much joy and satisfaction
in promoting healthy control
• Ultimately they feel truly “happy” and
genuinely “rewarded” when patients
comply and improve their outcomes
Why is this relevant to you?
• These techniques are not just for doctors
but for executives, patients, teens, etc.
• Anyone can be encouraged by these
techniques to be more candid and
authentic in their responses
• The “be creative” set-up and--contrary to
conventional wisdom--using projective
techniques first, loosen up all respondents
for deeper revelations about later topics
What are some important reminders?
• Use these techniques respectfully and only
when truly germane to the research objectives
• Don’t use them unless you fully believe in
them and can project your total confidence
• Don’t let respondents labor over these. Urge
“quickly, quickly” to allow time for other issues
later on
• Of course, you all know that Collage,
Storytelling and Sentence Completions are
certainly not new…
What are the new avenues?
• But the Heart Map, Psychodrawings
and Tarot Cards as stimuli do open up
new avenues for understanding and
communicating emotionally with many
types of difficult respondents
• In order to demonstrate how these
work, try using the handouts in the
context of your own job or product
category
Using the Heart Map, yourself, write
down aspects of your own career
• Closest to your heart, emotionally,
using spatial nearness and rank order
numbers
• Farthest from your heart, emotionally,
using spatial distance and rank order
numbers
• Share your favorite and least favorite
aspects with another colleague
• What do you have in common? How
are you different?
Using Psychodrawings, yourself,
compare users of two different products
• On the left side, draw the most typical user of….
(say, Zyrtec)
• Draw in facial features, draw/ label clothes
• First name, age, family, work status, health
• Draw/label holding most typical lifestyle object
• List 5 personality and 5 lifestyle adjectives
• Fill in full sentence of what person would say
• Now, on the right side, do the same exercise for
a competitive product user…(say, Singulair)
• What were the main points of difference? What
did you learn?
Using the Tarot Cards, yourself,
pick a card that resonates with you
• That best symbolizes your feelings,
beliefs and values about being a
doctor (or a patient) relative to a
disease state you work on
• Tell a story about that image that
dramatizes why you picked it
• With another colleague, brainstorm
together how Tarot Cards might fit
into insight mining your brands with
patients or doctors
Getting Doctors to Spill Their Guts
Innovative Ways to Dig Deeper
by
Patricia Sabena & Nicole Sabena Feagin
Sabena Qualitative Research Services
Westport, Connecticut, USA