Category: ThinkGen

Telehealth Use Up, Patient Satisfaction Down!!!

Check this out. What you will see is common sense as it applies to telehealth. Quite simply, the pandemic hastened the proliferation of telehealth platforms and of physicians ready, willing and able to use them. The fact that third-party payers, in many cases for the first time, compensated doctors for telehealth visits was a significant driving factor here. Just so, patients seeking safety and convenience stood ready to try telehealth visits during the pandemic.

BUT. Challenges in actually using the telehealth technology reduced patient satisfaction, as did confusion about treatment costs and lack of a “provider details.” Also, rather common sensical is the fact that telehealth is seen as being more satisfactory by the relatively well than by those in poorer health, who are looking for more support from their physician interactions. 

Bottom Line. All of these J.D. Power findings line up rather nicely with the results of my On Doctors’ MindsSM conversations, wherein doctors are telling me month after month that it is the less complicated, follow up patients, and those demanding special handling in terms of safety and convenience, who are now the only ones getting serviced through telehealth platforms. Especially for specialists, the loss of direct physical examination and patient relationship management inherent in telehealth visits causes most doctors to far prefer in-office patient visits. 

The Covid Vaccination Struggle and “Market Forces”

In my most recent round of 10 On Doctors’ MindsSMmonthly conversations with physicians about the impact of the pandemic on their private practices in primary care, cardiology, oncology, etc., I have been asked by several clients to talk about the impact of “market forces” on vaccination acceptance among their patients.

As I predicted in a previous post, the Pfizer vaccine receiving “FULL FDA APPROVAL” didn’t matter in a single practice with which I conversed. Patients simply have no idea of the difference between “Emergency Clearance” and “FDA Approval.”

For practices with large numbers of working patients, the possibility of a “VACCINE MANDATE” was predicted by my discussants to have a significant impact, although not without a lot of rancor as the picture above, on the left, would suggest.

By far, the best conversation I had on the topic of convincing patients to get vaccinated was with a cardiologist in the Bronx, who actually was the first US physician to contract COVID himself at the beginning of the pandemic. He tells skeptical patients that they are right.  The vaccine is a hoax, as is the pandemic. The 600,000 people who have reportedly died of COVID were actually taken to Area 51 in Nevada, where they are being kept against their will. Etc., etc.  At the end of this riff, he asks patients if they believe all of that. Most, not surprisingly, say “No!” His retort? “Then your only choice is to get the vaccine.” One patient shot back that he was going to have to “Evaluate the science further.” To which the cardiologist, obviously no shrinking violet, responded, “You’re a truck driver. How are you going to do that?” Sort of the current situation in a nutshell! 

But check this out. An ICU nurse’s graphic reminder that when you show up at the ER gasping for air, there are no more choices. Everything available for treatment, including intubation, will basically be forced upon you. No volition. No more “bodily autonomy.” 

Bottom Line. One thing that my discussants are telling me this month is that the only “market force” they have seen motivate a recalcitrant patient to get the vaccine is actually seeing someone close to them die of the disease. 

Question. How can we synthesize the impact of that horrendous but impactful experience and get it into widespread public distribution???

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!

Healthcare Inequity is Still Alive and Well

Pardon the tongue-in-cheek title for this post, but if you check this out you will see a very disturbing NYT article. Disturbing in that it summarizes recently reported metanalyses, demonstrating that in the first twenty years of this century, there has been virtually no narrowing of the healthcare disparity gap in the United States. That is unacceptable! That is a disgrace!!!

As many of you know, I spend a lot of time thinking about and working on healthcare disparity. Economic, racial, or any combination thereof. As Vice Chair of the Board at Hilton Head Island’s Volunteers in Medicine Clinic, serving over 10,000 patients who otherwise would be “unserved,” I am presented daily with the stark reality of this situation, which has been brought into even greater clarity by the pandemic. For example, I was recently informed that on Hilton Head, 70% of Caucasians are fully inoculated. That number is 40% for Blacks and 20% for LatinX. Why? Is this about access or attitude? Probably both, and a lot of other causes thrown in at no extra charge. Whatever the reasons, guess what COVID patients are filling the ICU beds at Hilton Head Hospital.

Bottom Line. As this NYT piece reasonably concludes, whatever we have been doing as a nation to move toward healthcare equity clearly is not working. We need to do something else. Something different. Something way bigger. 

Thus, while I laud the programs that healthcare companies are mounting to reduce disparity, I am afraid that the problem transcends the ability of these programs to eradicate the underlying problems here. 

We need to figure this out! And to make a difference so that 20 years from now, metanalyses will not once again be demonstrating no improvement on, perhaps, one of the most important metrics in existence today.

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!!!

Indefensible!!!

Want to get really angry about the human condition in 2021? Check this out. What you will see is a qualitative study that demonstrates that physicians of color are “routinely” subjected to significant racism. In fact, it’s a trifecta. They report being discriminated against by their institutions, by their colleagues and even by their patients. About one quarter of doctors of color reported that patients had actually declined treatment due to the race of the practitioner. Good grief!

And the authors of this piece use an interesting term, “microaggressions,” to refer to such experiences. Somehow, I am reminded of the old expression, “Like being nibbled to death by ducks.”  Something that happens slowly, inexorably, painfully. 

Bottom Line. In the end, the authors not surprisingly report that all of these microaggressions have a substantial negative impact on these physicians’ reported quality of professional life.

How could they not???

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!!!

Post-Pandemic Priority Shifting

Check this out. What you will see is a really important video from Bob Lederer at RFL Communications. The point being made here?

Numerous agency heads have observed that following the pandemic, virtually everyone is reshuffling their priorities. What was important before COVID-19 struck often isn’t so much anymore. Research suggests that both rich and poor are fundamentally reevaluating who and what “matters” to them given the learnings of the last 18 months. You can almost hear the wagons being circled, with an increasing focus on what is “near and dear.” 

For example. Conversations that I have been having recently with millennials have clearly indicated that they are less than pleased with the notion of returning to the office. After 18 months of working at home, the hour commute each way, that they never questioned before, now seems very onerous. A young lady I spoke with last night, a partner in a major investment firm, reported that she has gotten very used to putting a load of laundry in during the workday and “going for a bike ride at 5 PM.” After Labor Day, this will all disappear. Or will she??? Will a “hybrid” model, involving some days in the office and some days working at home, suffice?

Bottom Line. And the so what? Companies that claim to be empathetic with their customers need to get in touch with this new normal.

Think about what this might mean for your company, its employees, and its products!

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.