15 Practical Medical Moderating Tips

There are some tips that we shared with the class that we would also like to share with those of you who interviews physicians as well as other "Expert" populations -- lawyers, producers, directors, CEO's etc.

1. SCREEN FOR CREATIVITY:

Include a measure of creativity in your screening instrument. Doctors and other expert populations are prone to more rational, fact based verbal styles, which don't lend themselves very well to discussing reactions to advertising, imagery, or brand communications/equity. Nothing is more frustrating than trying to figure out how to ask a 'I go strictly by science and the facts!' physician which picture to use in your trade journal placements, or what tagline/positioning might be most appropriate for his patient population.

One very simple measure of creativity is called "ideational fluency", and simply corresponds to the number of uses someone can report in a given amount of time for a given object. For example, you might ask physicians on the screener "I'm going to time you for 45 seconds and I'd like you to tell me all the different uses you can think of for a paper clip". Throw out anyone who gives you less than 7 answers in that time period (10 if you want to be really careful). You'll find that the doctors remaining are more forthcoming and willing to use their 'right brain' to help you accomplish the goals of the project.

We have also developed a more sophisticated screening instrument (developed while Glenn wrote his dissertation on creativity) which involves rating several self-descriptive paragraphs. This technique targets physicians who are not only willing to be more fluid in reacting to advertising stimuli, but are also less competitive in group discussions. (We rent this screener on occasion - and are also in the middle of a large project to develop a national pool of doctors who have been screened using this technique. For more information, please reply to this email)

2. LEAN TOWARDS INDIVIDUAL INTERVIEWS:

If your budget allows, many times you'll get more in-depth and personal responses in a one-on-one where less posturing occurs. Doctors have been groomed in very competitive environments, ... so when you put them together, it's at least twice as hard to get around the p_ssing contest to their true reactions and motivations.

3. MOVE GRADUALLY FROM FACT BASED QUESTIONS TO CREATIVE TECHNIQUES:

One of the most effective methods of bringing doctors to a mental space where they are willing to discuss more deeply held motivating thoughts and feelings is to very carefully and deliberately move from factual questions to creative techniques. If done correctly, they almost won't notice the transition (kind of like weaning someone off coffee by very gradually replacing the caffeine-laden with decaf, first only 1/8th the cup, then 1/4, then 1/2, etc). Direct, factual questions are least threatening to them. (e.g. "Under what circumstances to you prescribe a beta blocker when dealing with men over 60?"). Analogies are just a little more towards the right brain (e.g. "If each of these blood pressure medications were a member of the New York Yankees, who would each be?"), Forced debates go a little further "OK, now you doctors on the left side of the room argue the merits of brand X, while the right side of the room argues against it", followed by "mild projectives" (e.g. imagine that every beta blocker came from one "family" ... now tell me about that family reunion - who is the mother, the father, the uncle, etc ... and what are they doing at the party?), to more serious projectives which require child-like thinking (please make a collage which would be an artist's representation of your average patient's day to day experience with this medication), to the most serious projectives (close your eyes and I will help you feel very relaxed ... then I will help you imagine a door with the medication on it ... when you step through that door you will find yourself in an entirely different scene, just like Alice did when she stepped through the looking glass...). Of course, understanding how to manipulate the specific parameters of projective techniques is essential to accomplishing this gradual move from the rational to the emotive/imagaic (HINT HINT... this is covered in our medical course, and more thoroughly in our intro to projectives).

4. RESPECT RESISTANCE:

Joseph F. Newton said (I'm paraphrasing) "People are lonely because they build walls instead of bridges". Robert Frost said "Before I built a wall I would think to learn what I was fencing out and what I was fencing in." It's very poetic, but what most people don't realize is that the reverse is also true. Because there is such a high price to be paid for building walls around oneself (e.g. loneliness), if you encounter a wall which someone built a long time ago (e.g. the physician's scientific communicative style), you can assume they had a darn good reason for building it. NEVER try to bulldoze through a physician's wall. Instead, educate yourself about how to support and reinforce it while helping them peak around just a little bit. When you respect people's walls, (particularly true for physicians) they have more courage to see what's on the other side!

5. EVERY DOCTOR IS DIFFERENT:

Learning a bit about each doctor's unique motivations early on in the interview will help you later to 'find their metaphor' and help them relax. Find out why they became a doctor? What is their earliest recollection of wanting to be a physician? Often this question, unearth some neat surprises about motivation as well as current disappointments - and knowing this can help you dramatically later in the interview. (It also helps the client in the back room to understand their reactions to the concepts/ads, etc). Some common motivations are:

To be good from parent's wish perspective - "My son the doctor"
Wanting to help people or other altruistic motives
Intellectual Curiosity
Love of science and scientific inquiry
Hero/superman wish
To have more relationships with people (especially FPs & nephrologists)
God like image/Priest
To look smart
To be a rescuer
Immediate gratification of solving a problem - (especially for surgeons)
Money
Power
Prestige

6. REMEMBER, YOU ARE THE EXPERT INTERVIEWER:

As the moderator, remember that you are the expert at what you do, no matter how much more Doc may know about his expertise. In this vein, it's also useful to remember the medical policy of '2nd opinions'. No one doctor is the authority on everything.

7. EXPECT DOC TO BE OPEN WITH YOU:

Physicians were acculturated in an environment which encouraged 'rising to the expectations'.

8. SHOW RESPECT, BUT DON'T RELINQUISH CONTROL:

Show respect and appreciation for their knowledge/expertise, but avoid being obsequious.

9. UNDERSTAND THE 'DOC' DWARF PERSONALITY:

(Note - don't know what a 'dwarf personality' is? Want to find out your own? Visit Snow White Test)

As they are prone to let you know, Docs actually are natural born leaders. They live in a world of possibilities where they see all sorts challenges to be surmounted, and they want to be the ones responsible for surmounting them. They have a drive for leadership, which is well-served by their quickness to grasp complexities, their ability to absorb a large amount of impersonal information, and their quick and decisive judgments. They are "take charge" people.

Docs are very career-focused, and fit into the corporate/medical/academic world quite naturally. They are constantly scanning their environment for potential problems which they can turn into solutions. They generally see things from a long-range perspective, and are usually successful at identifying plans to turn problems around - especially problems of a strategic nature. Docs are usually successful, because they are so driven to leadership. They're tireless in their efforts on the job, and driven to visualize where an organization is headed. For these reasons, they are natural leaders.

There is not much room for error in the world of Doc. They dislike to see mistakes repeated, and have no patience with inefficiency. They may become quite harsh when their patience is tried in these respects, because they are not naturally tuned in to people's feelings, and more than likely don't believe that they should tailor their judgments in consideration for people's feelings. Docs have difficulty seeing things from outside their own perspective. Docs naturally have little patience with people who do not see things the same way as they do. Doc needs to consciously work on recognizing the value of other people's opinions, as well as the value of being sensitive towards people's feelings. In the absence of this awareness, Doc can be a forceful, intimidating and overbearing individual. Doc has a tremendous amount of personal power and presence which will work for hi m as a force towards achieving their goals. However, this personal power is also an agent of alienation and self-aggrandizement.

Docs are very forceful, decisive individuals. They make decisions quickly, and are quick to verbalize their opinions and decisions to the rest of the world. A Doc who has developed in a generally less than ideal way may become dictatorial and abrasive - intrusively giving orders and direction without a sound reason for doing so, and without consideration for the people involved.

Although Docs are not naturally tuned into other people's feelings, these individuals frequently have very strong sentimental streaks. Often these sentiments are very powerful to the Doc, although they will likely hide it from general knowledge, believing the feelings to be a weakness. Because the world of feelings and values is not where Doc naturally functions, they may sometimes make value judgments and hold onto submerged emotions which are ill-founded and inappropriate, and will cause them problems - sometimes rather serious problems.

Docs love to interact with people. As Extroverts, they're energized and stimulated primarily externally. There's nothing more enjoyable and satisfying to Doc than having a lively, challenging conversation. They especially respect people who are able to stand up to them, and argue persuasively for their point of view. There aren't too many people who will do so, however, because Doc is a very forceful and dynamic presence who has a tremendous amount of self-confidence and excellent verbal communication skills. Even the most confident individuals may experience moments of self-doubt when debating a point with a Doc.

10. UNDERSTAND YOUR PERSONAL REACTIONS TO DOCTORS:

It is extremely important to explore your OWN personal emotional reactions to physicians in detail, because more so than any 'technique' you can learn in a textbook or a course, what makes you or breaks you in the interviewing room is your level of confidence and poise.

What are some of your earliest memories with physicians? What attitudes were you taught about how to behave, think, and feel in their presence? How might these help/hinder your performance as a medical interviewer?

11. USE OFF TASK ICE-BREAKERS FOR PHYSICIAN GROUPS:

It's important to remember, (particularly in today's managed care climate) that physicians live with intricate emotional pressures during their working days. Liability concerns, note-taking, and the emotional contagion of the pain/discomfort their patients are experiencing all take their toll.

A go-round, early in the group, in which the doctors are asked to relate the most difficult part of their day often eases the tension and makes room for them to think creatively. Participants should be instructed to summarize their stories in one minute or less. A brief, sincere, empathic response by the moderator (e.g. "It's really incredible what physicians have to face every day") two or three times during this exercise will go a long way towards gaining respondent participation in creative exercises

12. SIMPLY TELL THEM TO BE CREATIVE:

If approached properly, doctors welcome the opportunity to loosen their ties and be creative! The difficulty is that many moderators ignore the fact that doctors are constantly "on the line" or being evaluated in the hospital environment. This puts them in the mind set to "produce the right answer," which counters their creativity (and increases stress). Few moderators are trained to eliminate or suspend this mind set.

One simple way to encourage a creative mindset is with instructions: "Be creative, there are no right answers, and no wrong ones. By the way, research shows that it really pays to put aside judgements of your ideas in a group process like this until they are all out on the table. That's because we want everyone to get a chance to associate to your ideas, even if you may think the idea is not so hot."

13. LET THEM LEAVE THEIR BEEPERS ON:

Have you heard this one? "You can't get a doctor to take off his beeper in a focus group." Well, the truth is, you can, but you shouldn't! A beeper is a doctor's connection to his practice. When you remove it, you create high anxiety which is counterproductive to group process. If a beeper goes off, turn to the doctor and ask her if she needs to make a phone call. If she says yes, then direct her to the phone and ask her to please hurry back: "We'll try to wait for you for the next exercise". Don't be too demanding, or too generous.

Keep in mind that your affect (tone of voice, facial expression, body language, etc.) should communicate the importance of both events (the doctor must return the phone call, and you must conduct the group). We have found that, with this approach, 4 out of 5 times the doctors say that they can wait to return the call.

14. DOCTORS DO NOT HAVE A DIMINISHED ATTENTION SPAN FOR ADVERTISING MATERIALS:

Doctors, of necessity, are forced to push their capacity for "secondary process" (logical, rational, goal oriented) thinking past its limits on a daily basis. This leaves them feeling intellectually drained and much more willing to discuss their handicaps on the golf course than their perceptions of a new drug or advertising campaign. Fortunately there are several efficient psycho-social techniques which can be applied by a trained moderator to re-energize and pique a doctor's interest. One of these techniques is to concede a limited amount of time during the group to discuss golf or whatever other distraction is on their minds. This provides a rest period from analytical thinking, and they often come back refreshed and ready to work for you. This discussion must be structured by the moderator however if she is to remain in charge.

15. EXPECT TO WORK HARDER WITH MALE DOCTORS AS COMPARED TO FEMALE:

There is a documented difference between sexes indicating that women are significantly more willing to discuss emotions than are men. We believe that this pre-existing difference is intensified by the "no emotional involvement" philosophy which is so often preached by the medical establishment. Since openness to one's internal processes is often a cited pre-requisite for creativity, male health professionals may suffer on this attribute. A trained moderator can easily minimize these differences and help individuals discuss emotional issues relevant to creative marketing research. The key is to create an atmosphere unlike the typical work atmosphere, but not so loose as to encourage `cocktail hour' chatting and subgrouping.

16. CALL THEM "DOCTOR":

(I lied . . . looks like I have a #16).

Although it may be unfounded, experience has shown that doctors are somewhat insulted when addressed by their first names unless they volunteer it first. They worked VERY hard for their title, and, especially since many of the other rewards they expected never materialized (e.g. the money which used to be associated with medicine), they often seem to feel as if their status and life achievements have gone unrecognized when someone assumes the right to use their first name. This is even true for interviewers who also have a doctoral degree. I (always call physician's "doctor" unless instructed otherwise by them. I also have a nametag with my first name right in front of me, and introduce myself as "Sharon". (Glenn does the same thing).