Category: On Doctors’ Minds

Does “Confidence” Cause “Action???”

Here’s an interesting one. A recent Harris Poll indicated that formal FDA approval of Comirnaty increased respondents’, both vaccinated and unvaccinated respondents, “confidence” in the vaccine. Interesting thought in and of itself. Reading this left me to ponder how many people could outline, even at the 20,000-foot level, the differences in the hurdles that a vaccine has to clear in order to obtain “emergency approval” versus “FDA approval.” I certainly couldn’t and look at what I do for a living!

The plot thickens. According to this same article, about 50% of those who are unvaccinated are moved enough by this increase in confidence that they “probably” or “definitely” will be vaccinated, and about 60% of parents are now willing to get their children vaccinated. Color me skeptical on that one. Talking with patients on the topic of vaccination, I have heard religious objections. I have had patients say that they are afraid that the vaccine since it is “Messenger RNA,” will alter their genetic makeup. Or have a negative impact on their fertility. Then there are those who believe that the vaccine will “magnetize” them or allow the government to track their movements. Does “FDA approval” relieve them of these objections?

Bottom Line. Just as I had finished reading this piece, I was scheduled to do one of my On Doctors’ MindsSM conversations to get an update for our hundreds of subscribers as to what is happening in office-based practices as a result of the pandemic. This doctor, a more senior primary care physician in a rural practice in Pennsylvania, offered that about 60% of his patients had been vaccinated and that he saw little likelihood of any more doing so. He has tried hard to get the balance to get vaccinated, but to no avail.

Survey research results versus the opinion of a physician with 50 years of experience under his belt. Which do we believe? Oh, and other factors, like major corporations, government agencies and academic institutions now feeling empowered to issue vaccine mandates given FDA approval might well have a significant impact on the outcome here.

What will Cominarty’s approval translate into in terms of new patients journeying out to get the “Fauci Ouchie?” 

Stay tuned!

The Ethics of Telemedicine

In my On Doctors’ MindsSM research that tracks the adaptations that office-based physicians have made to the COVID-19 pandemic, I have been fascinated to learn about how quickly clinicians were able to adapt to telemedicine, and some of the hurdles they encountered going up the learning curve involved in using this new technology.

But check this out. What you will see is a discussion of whether it is ethical for a physician to limit the treatment of unvaccinated patients to telemedicine visits. Survey results revealed that 69% of doctors thought this was ethical given the risk such patients pose to medical staff. A medical ethicist weighing in on the same topic agreed, but put in the caveat that if a patient’s condition requires personal contact for good treatment, e.g., in the management of a movement disorder, it was incumbent upon the practitioner to either allow personal visits or refer the patient to an HCP that would provide such service.

Bottom Line. Think about it. The COVID-19 pandemic brought with it, among many other things, a slew of new and important ethical questions with which healthcare providers must wrestle daily. As with so many aspects of the pandemic, I am thinking that the results of these wrestling matches will substantially modify thinking in the field of medical ethics for years to come.

If not forever!

Never Again!!!

Check this out. What you will see here are a lot of important observations and very meaningful words.  Like the assertion that COVID-19 caused the “moral crippling” of ICU nurses. Code for they could no longer do their jobs, the way they used to love to do their jobs, during the pandemic. Too many patients. Too little PPE.

And the irony of hospitals offering ICU nurses $5,000-$6,000 a week in compensation. In exchange for putting themselves and their families at risk. Feels almost like a perverse bribe, although Lord knows they earned every penny and more.

OH. And the balloons and music at the hospital doors. People yelling that they are heroes. But none of them is feeling like a hero. 

Bottom Line. And the greatest irony of all? The phrases toward the end of the piece. “We finally see the numbers go down. A sigh of relief.” This in piece written just over a month ago.

And the prayer. “Never again.” But here comes Wave 4. Can these nurses do this reprise? Their patients have to hope so!

God bless them one and all!

One Confused Physician

Check this out. What you will see is the rather amusing story of the day that Dr. Anthony Fleg, pictured above, unknowingly held a 20 minute “telehealth” visit with a patient who was sitting in an examination room in his clinic.  In a day comprised mostly of virtual visits, he had missed the intake note that said “Room 11.” A sign that things were starting to “open back up” in primary care. Also, a sign of just how confused the pandemic has gotten all of us, with those in the front lines of healthcare being particularly vulnerable.

Bottom Line. Sitting here as July transitions into August 2021, I wonder. I wonder what kind of confusion will be caused by the CDC once again flip-flopping on mask recommendations for the vaccinated. By Pfizer and the FDA trying to make sense of the need (?) for a booster shot. By doctors once again, without much guidance from anybody, trying to decide whether to close their offices and revert to telehealth. 

Every single doctor with whom I have held a conversation during the monthly iterations of my On Doctors’ MindsSM  project has told me that it has been confusion that has been the worst part of the pandemic. Lack of guidelines. Inconsistent guidelines. Unclear future. Unclear timing. You name it. 

As I listen to the news today, I think that we are unfortunately not done with this confusion!  

Understanding Black Americans

Check this out. What you will see is a piece on the importance of gaining a better understanding of the 13% of Americans who are black. You will also see the author observe that many brands and companies have not done a very good job in gaining this understanding, or even in trying to do so, and are increasingly being called out for their ignorance.  

This got me to thinking as usual. Three thoughts come to mind. First, having been actively involved in pharmaceutical marketing research for the last 40 (or more!!) years, I can’t recall ever being asked to conduct a study related to understanding Black Americans. That’s not a good thing.

Next thought. It is generally understood that in order to break down healthcare disparity, we need to do three things. First, we need to understand medical differences across segments of the population. For example, our gastroenterologist at Volunteers In Medicine on Hilton Head Island recently explained to our board that H. pylori is present in about 33% of Caucasians, 66% of African Americans and about 77% of Latinx patients. Given that 90% of our 10,000 patients are of color, that’s pretty important stuff for him, and for us, to know to ensure proper testing protocols for GI cases.

Second, and this is where marketing researchers come in, we need to understand the cultural differences alluded to in this article. Blacks’ hesitancy to get vaccinated for COVID, and the relationship of this reluctance to the Tuskegee experiment and numerous other situations in which Blacks were medically abused, has significant explanatory power if we take the time to understand such issues. 

And finally, mindful of the above, we need to find creative ways to actually deliver health care to the underserved. VIM is a clear example of such a delivery mechanism.

Bottom Line. Things are changing. Health care companies are mounting significant programs to reduce health care disparity. J&J’s “Race to Equity”, The Novartis “Beyond Words” program, etc.  AND.  The ThinkGen team is starting to research relevant issues. Like doing ethnographic research with “free clinics” to find out how they work, learn about their patient segments, etc. Such knowledge is clearly necessary to guide the disparity reduction programs that pharmaceutical companies are mounting.

Exciting new times!!!

Are Physical Exams Obsolete?

Sometimes! Check this out. What you will see is a post by our friend, The Country Doctor, who argues that such examinations are often conducted without a good reason.  and perfunctory. As evidence, he offers the successful journey that most physicians made into telemedicine during the COVID-19 pandemic, successfully treating patients without laying eyes or hands on them. 

BUT. The conversations I have been having with physicians for my ongoing On Doctors’ MindsSM project have clearly indicated to me that many of them feel otherwise. For them, telemedicine was a necessary, temporary adaptation to permit their practices to go on rather than being put under, in terms of both patient care and finances, by the coronavirus.  Now that offices have reopened to personal visits, telemedicine is being relegated to extremely limited use, if any. Doctors report that they need to observe their patients to get the full picture of what is going on. Specialists in fields from cardiology to neurology have specific evaluations that they want to make, and they have to be done in person.

But is the same thing true for PCPs in a “routine” office visit? A brief story. When my wife and I moved to Hilton Head Island almost a decade ago, we promptly joined the concierge practice of what we were told (and it is true!) was the best Internist in Beaufort County. On my wife’s first visit, the physician laid her hands on my wife’s throat and “felt something.” Scroll forward and her cancerous thyroid was summarily removed. A good “routine” physical exam? Damn straight!

Bottom Line. I get the Country Doctor’s point.  Sometimes physical exams look a lot like “going through the motions” for no reason whatsoever.  BUT. To catch the unanticipated, as well as to build patient relationships, they are probably about as far from obsolete as they could possibly be!!!

Fewer Physician Visits By PSRs Post-Pandemic?

As you will see in these survey results from FirstWord, that is the desired scenario for about half of the 100 doctors they polled. Throughout the six months of reporting on the results of my On Doctors’ MindsSM conversations, that about lines up with what I have been finding. As we predicted back in November of 2020, many doctors are looking forward hopefully for a return of the “old normal.” BUT. About half of all physicians we have talked to, and especially many specialists, have learned over the course of the pandemic to “do without” PSRs, readily getting  the answers and information they need in their practices from other sources. 

While you are looking at these results, check out the data concerning virtual details. Here, 57% of doctors reported that they find them to be equally or more “effective” than personal PSR visits. BUT. In my conversations with physicians, the majority of doctors are avoiding these virtual visits like the plague (Sorry!) due to difficulties in scheduling and the extra time required. Translated, perhaps the virtual details that are happening are “effective,” but most of my discussants, and I believe most physicians more generally, are not letting them happen.

Bottom Line. Throughout our study of the effects of the pandemic on office-based physicians, we have been telling our pharmaceutical clients that they had best be prepared to increase their physician micromarketing sophistication as the pandemic winds down. Doctors are differing widely in their preferred mode of communicating with pharmaceutical companies. One size definitely doesn’t fit all here, and we need to be ready to respond to these differing physician preferences. 

On Doctors’ Minds April/May 2021

ThinkGen, partnering with Olson Research, has just released its findings from the April/May edition of our ongoing On Doctors’ MindsSM project. The in-depth conversations held with physicians this time around were scheduled and oriented so as to provide our clients with insights from physicians as to what the post-pandemic “reopening” will look like.  

Take five minutes of your time and listen to four physicians, discussants in the April/May round of conversations, talk about what the “new normal” is going to look like. Guess what! It’s going to look pretty much like the old normal!!! You will hear two physicians comment, as so many of our respondents have, that “virtual details” just take too much time to fit into their schedules. You will hear a PCP describe the lunches that are brought in for her staff every day by Pharmaceutical Sales Representatives seeking to gain presentation time and build relationships within the practice, and finally you will hear a Cardiologist describe the important role that samples, delivered by PSRs, continue to play in his practice.

Bottom Line. Despite all of the talk about pharmaceutical promotion changing fundamentally and going digital, that’s not really what the new normal is shaping up like. Yogi Berra said it so well. “It’s like déjà vu all over again.”

You can enroll in our ODM program here:

Physician Wellbeing

Check this out. What you will see is the sign up for a lecture on the topic of “physician wellbeing” given by the University of Pennsylvania psychiatrist pictured above. As a long-time student of physician burnout and suicide, I find it gratifying to see the words “physician wellbeing” used together.  

This piece starts out with an important quotation:

“Physicians came into the COVID-19 pandemic on the heels of an epidemic of burnout and discontent.”

Amen. And as the 10 conversations I have been having every month with physicians for my On Doctors’ MindsSM project have convinced me, the pandemic has made the preexisting problems worse by an order of magnitude. Uncertainty. Health Risk. Stress. Change. All of these have been the story of physician life through 2020 and into 2021.  

BUT. As this presentation points out, there are actually interventions that can be employed to restore and to protect physician wellbeing.  

Bottom Line. Clearly this obscure little Grand Rounds lecture is not going to solve the current crisis in physician wellbeing. A lot more muscle has to be put to the accomplishing of this goal. Or even making a dent in the problem

But what can we do? I’m guessing that rather than beating doctors about the head with “reminder details,” we in the pharmaceutical industry might do a lot more to enhance our relationships with physicians, and to foster their loyalty, if we put our considerable resources to work building up physician wellbeing rather than actually being potential contributors to its degradation!

Skipped Appointments

Check this out. And, this as well. What you will see at both URL’s are teasers for WSJ articles discussing the impact of patients skipping medical appointments during the pandemic. From postponed colonoscopies to delayed detection of diabetes, most experts believe that it will be a decade or more until we realize the full impact of this procrastination. As one Oncologist discussant in my On Doctors’ MindsSMconversations reminded me, “Cancer has a long tail.”  

Two driving factors here. Institutions being shut down for routine visits and elective procedures over an extended period of time didn’t help. Patient fears about being infected with COVID in a medical setting are even more long lasting and are still causing delays in medical treatment.  

As we have discussed before, only well on into the months of the pandemic did we start to see advertisements by pharmaceutical companies encouraging patients not to postpone needed care.

Bottom Line. So, I wonder. What did we learn from this that will cause us to do something differently the next time? And who is the “us” that is responsible for keeping healthcare on track???