Dante Murphy is responsible for ideation, research, methodologies and building a world-class multi-disciplinary design practice at Digitas Health. MedCrunch recently caught up with him to find out more about effective communication between patients and physicians.
MedCrunch: How can we make sure that patients and physicians communicate better and what role does design play in this process?
Dante Murphy: That’s a great question. There are so many layers to this answer. In many cases, I would say that it’s dependent on the medical condition. If we ask the question: “How do physicians communicate with patients about lowering their cholesterol?” the typical way that doctors handle it is through inculcation of the message: “You need to change your eating habits”. Say type 2 diabetes risk. My doctors tell me “Just drink one less soda a day.” He repeats it every time I see him. Guess home many times it has worked? None; it doesn’t even work that same day because it’s a ineffective way of delivering the message. It’s sort of nag oriented.
That’s a very different conversation from one with a middle-aged person about effective Alzheimer’s treatment or dementia care. Metastatic cancer: that’s a totally different conversation. Sexually transmitted disease: that’s a totally different conversation. There are so many condition-specific factors to take into account. That’s why I am referring to the need of understanding what the factors that influence a specific conversation are. It’s impossible to tackle a conversation by generalizing it; there is no such thing. It matters whom you are talking to and what the situation is. I think that using any sort of solution framework to help identify what the real factors are is essential. Is there shame? Is there fear? Is there resistance? Is there misunderstanding? Is there a cultural barrier? When looking at the latter, an example would be telling people from a certain culture to not eat so many carbohydrates; don’t tell Italians not to eat pasta. It’s ridiculous. Figure how to have the right conversation.
MedCrunch: So you would target it?
Dante Murphy: You have to. Targeted communication works. Look at advertising: you could put a billboard up on the side of the road that says: “Join the army”. Some people will see it and go: “I should maybe think about joining the army.” But they’re in their car; they’re not at the point of action. Do you know where the most effective military recruiting happens? At high schools. It’s where the target population is located and where there is the ability to commit the sale –if you think of it as a sale. Targeted communication works. Broadcast communication often doesn’t: there are things that it can do, but it’s like shooting in the dark.
MedCrunch: Technologies are being created with a big focus on the patient. How can self-reported data be translated into the physician being involved and becoming an integral part of the process?
Dante Murphy: Physicians are trained in evidence-based medicine. They’re trained to have scientific rigor around their decision-making process and there is not very much scientific rigor around the value of motivating apps or games. Although, from Jane’s talk we know that a body of evidence is most definitely present. Getting physicians to be true believers in apps and games is a sea change. It’s gathering momentum but we’re not there yet. What is compelling about it is that our Chief Mobile Strategist identified a situation where several health insurers are willing to reimburse the WellDoc’s DiabetesManager health app. These reimbursement models will not only build the body of clinical evidence but also include the experiential evidence. Doctors often talk about the difference between scientific efficacy -which is what was exhibited in the clinical trial- and effectiveness. The clinical trial is like the difference between theory and reality: it mirrors it and it predicts the outcome. The actual effectiveness is how the stuff really works in the real world with an uncommitted patient population in the broadest possible sense. Doctors will start adopting these products only after the effectiveness of the app is being proven.
The other thing that is compelling about physicians’ mind shift towards apps and gamification happened during some of the research that I did. Our team was conducting telephone-based interviews that included screen sharing with physicians. We would ask a doctor a question; when he or she gave us an answer we would tell him “now go show me” in order for us to be able to see the process through his or her screen. It’s a great way of finding out people’s difference between their recollection and their behavior and is now one of my favorite techniques. A conversation with one of the doctors went as follows:
Doctor: “One of the websites I go to every day is whoisthesmartestoncologist.com*”
Digitas Health Team: “For real?”
Doctor: “For real.”
Digitas Health Team: “So you really go there every day?”
Doctor: “I go every day.”
Digitas Health Team: “Have you gone today?
Doctor: “I haven’t”
Digitas Health Team: “Would you mind going now?”
Doctor: “Hold on, let me get in the zone.”
He took it very seriously. He went through the website with us. He got to answer the questions quickly and he said: “I got three out of five right, which is not that great, but I did it fast. Maybe I’ll score some more points later today. I really should have known number four; after I saw the answer I remembered the journal it was in. I didn’t know number five, I’m going to look that up.”
What just happened? There is clearly an appetite for gamification within the healthcare space; it’s no longer only about the consumer space. The idea of prescribing an app for wellness and integrating it with Electronic Health Records (EHRs) is astonishing. When things like this start to blend together, you’ve got the breakthrough of what technology is capable of achieving in healthcare. But you still need the right solution to the right problem.
MedCrunch: What would you recommend physicians?
Dante Murphy: Make everybody, not just doctors, aware about what the truth about their own communication strategy is. To illustrate how communication is incredibly crucial, I explain it through the above-average syndrome example. If I put a hundred people in a room and say “everybody close your eyes. If you think you’re an above-average driver raise your hand” 96 arms will go up. One of those 96 people knows that he or she is a terrible driver and the other three just don’t drive. That’s the reality of it. Though the mathematics of it is that approximately fifty hands should go up. There is truly evidence to suggest that half are not above-average drivers. I did a similar experiment asking about effective communication for patients with epilepsy and doctors treating those patients. All of the patients said: “My doctor doesn’t listen, my doctors doesn’t care”. All of the doctors said: “I’m a compassionate healthcare provider and my patients understand what I’m telling them.” Guess what the truth was? Somewhere in the middle. Nevertheless, all doctors said: “I’m an effective communicator and I’m compassionate about my patients.” We then did a role-playing exercise and we had a faux patient come in, which said: “Yes doc, I know that my epilepsy medication says. I know I’m supposed to avoid alcohol, but I’ve got a stressful job, I get home late and I just have one beer to chill out at the end of the day”. The doctor replies: “Well, you’re not taking your therapy seriously. I think you should see another doctor.” Now, this was a doctor who emphatically insisted that he was compassionate. I want to believe that he had the best interest of his patient at heart and wanted the patient to see another doctor who would more effectively deliver care, but does that sound like compassion to you? So my advice would be: peel away the bullshit and make people aware, really think about how you communicate your message. Ask patients if they understand.
If my doctor and I were both really honest with each other, we would be able to tackle the problem. Communication and honesty; it has nothing to do with technology. Technology can be a part of it, but not a magic wand.
*Whoisthesmartestoncologist.com recently got bought out by one of the healthcare communication giants. Now there is not just oncology, but endocrinology and other specialties At the time it was only for oncology and was sponsored by a company focused on continuing medical education. The prize for winning would be a CME course, which doctors need. The questions were all from peer reviewed scientific literature, so it had clinical value.
Dante Murphy, Global Experience Director, Digitas Health
At Digitas Health, Dante Murphy is responsible for ideation, research, methodologies and building a world-class multi-disciplinary design practice. His nearly 20 years of experience designing, developing and testing applications include serving as a principal information architect at GSI Commerce. His career in the healthcare and pharmaceutical industry began at Merck & Co., Inc. Dante has presented at conferences and professional symposia across North America and Europe. He has conducted collaborative research on four continents and recently presented at the 2013 Healthcare Experience Design Conference. Dante is currently an adjunct faculty member at Philadelphia University, and his research has been published in MedAd News.