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Top 7 Insights from Years of Observing
Real-world Healthcare Communication
June 2016
2
With all of the changes in the healthcare industry over the past several
years, patients and healthcare providers are feeling more pressure than
ever to seek and deliver effective care. The healthcare universe is broad
and ever-changing, with many outlets for learning, sharing, and
supporting others. However, one thing has not changed—the
foundation of healthcare is communication. What is said (or not said)
during office visits, and how it is said, play a critical role in the success
of patient care. Successful communication is the key, but so often there
are misunderstandings and missed opportunities.
Sociolinguistics is the study of language use in society, and the study of
society through the lens of language. It is a broad interdisciplinary field
with many traditions of study, providing the tools to analyze the various
forms of healthcare communication.1 Discourse analysis, interactional
sociolinguistics, ethnography of communication—these are only a few
of the traditions of study, each with its own techniques, that can not
only shed light on what patients, healthcare providers, and others are
saying, but also on how, why, and what it means. For pharmaceutical
brands and the healthcare industry, this is paramount. Over the past 15
years, the Ogilvy CommonHealth Behavioral Insights team has used
sociolinguistic techniques to study and improve healthcare
communication. We spearheaded this research by studying dialogues
between patients and healthcare providers using our proprietary
methodology, which allows us to observe real-world office visits,
through unobtrusive video- and audio-recording, and compare what is
said with what providers and patients take away. We conduct post-visit
interviews that are structured to gauge alignment and are tailored to
specific category and brand needs. This research is IRB-approved and
HIPAA-compliant, which has enabled us to produce over 50 peer-
reviewed publications in primary healthcare journals, posters, and
presentations at national congresses. We have also applied the insights
gained from this research in the creation of patient education
materials, dialogue guides, and other tools to enhance care.
Recruit physicians
who then identify
appropriate
patients
Record office visits
Interview
physicians and
patients
separately after
their visits
Analyze dialogue
and triangulate
results
Ogilvy CommonHealth Behavioral Insights
Managing the Dialogue®
In-office Linguistic Research
3
In recent years, we have expanded our research and have developed
methodologies that study healthcare communication outside of the
exam room, providing a 360° understanding in a given healthcare
category:
 Social Monitoring and Insights: We listen to what is being said
online and apply sociolinguistic techniques to identify behavioral
insights, going beyond traditional social listening research.
Studying what patients, caregivers, and others are sharing online
in a category provides important insight into their experience
and needs.
 Computational Lexical Analysis: Combining big data analytics
with human interpretation, we study the language and linguistic
trends being used in peer-to-peer literature surrounding a brand
to provide recommendations for a strong brand lexicon—
ensuring that the words and phrases used to describe the clinical
story are accurate, differentiating, ownable, sustainable, and
evocative.
 Day-in-the-Life Ethnography: We observe patients and
caregivers during their daily life to understand their disease
experience and then perform in-depth motivational interviews
to learn about their journey, uncover their beliefs and rationale,
and identify disconnects between what they do and what they
say they do.
4
56%
32%
12%
Average Percentage of Words Spoken
by Participants During Office Visits
Physician
Patient
Others (e.g. visit companion, nurse, medical assistant)
Through our research observing healthcare communication, we have
discovered some pervasive trends and insights:
1. Physicians dominate the office visit
discussion.
Physicians speak an average of almost 60% of the words during
office visits.
5
2. Physicians typically ask questions that
restrict patient answers.
Physicians often ask closed-ended and short-answer questions
rather than open-ended questions that would allow patients to add
new information and perspective that they may not have shared
otherwise.
Note: All dialogue examples are similar to those that would be
found in real in-office communication.
6
3. Patients often take a backseat in the
visit discussion.
During office visits, patients often assume that physicians will let
them know everything that they need to know and ask them for
any important information. However, they are often left without
answers, or with more questions. More and more patients and
caregivers are going online to educate themselves and to
participate in online communities, having discussions, sharing
information, and supporting each other, but they are not always
bringing this initiative to their interactions with healthcare
professionals.
In this age of patient health literacy and advocacy, when patients
are being expected to take more responsibility for their own
healthcare choices, it is important that patients apply that principle
during visits with their physicians, asking questions and
volunteering information that they think is important, even if the
physician does not ask.
7
4. Quality of life impacts are typically
overlooked.
Physicians rarely ask patients about the impacts of their condition
on their quality of life. We often hear this is because physicians are
pressed for time and assume patients will tell them about quality
of life impacts if they are significant. Patients often do not bring it
up because they do not think the physician wants or needs to hear
about it—they view it as their personal struggle. Also, certain
diseases that significantly impact quality of life can be
embarrassing for patients to discuss with their physician.
This dynamic can be particularly detrimental in conditions that
significantly impact quality of life, such as respiratory conditions
including asthma and COPD, as well as overactive bladder. With
overactive bladder, the condition can be easily disregarded and go
undertreated. Patients with overactive bladder are often unable to
do activities that they used to do, because they need to be near a
restroom at all times. This is especially true if they experience
incontinence, and need to wear pads or diapers, which can also be
embarrassing. However, many patients do not share these impacts
with their physician, because they are embarrassed due to the
stigma or believe this is a normal part of aging.
8
5. Treatment goals are rarely discussed.
Physicians rarely discuss treatment goals with patients, and if they
do, they are often vague and difficult to benchmark. Patients
assume that they know the treatment goals and are aligned with
their physician.
We have seen this dynamic play out in visits with physicians and
patients who have a variety of conditions, including insomnia and
ulcerative colitis. Patients with ulcerative colitis view treatment
success as clinical remission, or lack of symptoms. However,
physicians define it as both clinical remission and endoscopic
remission, or lack of inflammation in the colon. Thus, once patients
reach clinical remission, they believe they have achieved the goal
of treatment and may not understand why further or more
intensive therapy may be necessary.
9
6. Diagnosis of terminal conditions is often
unclear and patients are left unaware.
If they do not see therapeutic benefit, physicians do not always
clearly communicate a terminal diagnosis to patients, because they
want to “first do no harm.” Unfortunately, this can be ultimately
harmful to patients and their loved ones, because they may not
have the same opportunity that they would have had to plan for
the future. Patients often assume that physicians would share a
diagnosis with them if there was one to be shared.
We have seen this dynamic play out in visits with physicians and
patients who have a variety of conditions, such as metastatic
breast cancer and Alzheimer’s disease. Since Alzheimer’s disease
causes a loss of identity and is thus perceived as a form of death in
American society, it is a taboo subject surrounded by euphemism
and avoidance. Without treatments that make a significant
difference, physicians often do not see any benefit in explicitly
telling patients that they have been diagnosed with Alzheimer’s
disease, but instead speak around it, referring to the patient’s
condition as “memory” and other vague terms. Patients assume
that if the physician had diagnosed their symptoms, they would
have told them. Thus, patients assume that their symptoms are
caused by normal aging, and they do not get the same opportunity
they may have had to make plans for their inevitable decline.
10
7. Poor communication leads to poor
outcomes, and good communication
does not have to take more time.
Misunderstandings ultimately result in patients not getting the care
they need from physicians, such as not being prescribed treatments
that could help them, and patients not being adherent to treatments
that they are prescribed. For instance, in the case of overactive
bladder, there are many medications and lifestyle interventions that
could help patients, but with physicians underestimating the impacts
on quality of life, they are complacent about changing patients’
treatment. In the case of ulcerative colitis, patients are often
nonadherent to treatment because they do not understand that the
goals for treatment go beyond what they can observe—when their
symptoms recede, they believe they have achieved success, which is
unfortunately not always the case.
Our research has shown that the addition of an open-ended question
does not have to lengthen the visit. In fact, it may shorten it, and it
provides key information that leads to more physician-patient
alignment post-visit and patients ultimately receiving appropriate
treatment. In the first phase of a two-phase interventional study on
the communication between physicians and migraine patients, we
found that physicians use closed-ended questions to assess migraine
symptoms, focusing on frequency and paying little attention to
impairment—leading to physicians underestimating impairment when
asked post-visit and resulting in patients being deemed as “not
needing prevention.” During the intervention, physicians were trained
to ask one open-ended question about impairment, “How do your
migraines affect your daily life?” In the second phase of the research,
we found that by physicians asking this open-ended question, it gave
patients the opportunity to tell their story—without significant time
spent (median 9:36 versus 11 minutes)—and compared with baseline,
significant improvement was observed in frequency of discussion and
prescription of preventive therapy, physician and patient satisfaction,
and alignment on impairment and frequency between physicians and
patients.2
11
Conclusions
Physicians are the experts in medicine, but patients are the experts in
their own experiences. Communication is a two-way street and
nowhere is this more important than during an office visit—this is the
backbone of patient-centered care and shared decision-making.
We must incite behavior change to improve healthcare
communication. Every therapeutic category and condition is
unique. We can help you to first understand the dialogue and
then to impact communication in your category in various ways:
 Dialogue tools to guide visit discussions
 Educational materials for patients
 Physician training programs
 Advisory boards engaging key opinion leaders
 Primary publications
 Posters and podium presentations at conferences
 Public relations materials
This is just an overview, so if you want to talk about conducting
physician-patient in-office communication research, online social
monitoring, how best to promote your brand using patient-education
materials and dialogue tools, or our other methodologies and pull-
through possibilities, we are just the team to help.
Additional Answers
Ogilvy CommonHealth Behavioral Insights will gladly answer any
questions you have pertaining to this document or to any topics
involving physician-patient in-office communication, online social
monitoring of patients and caregivers, how best to promote your brand
using patient-education materials and dialogue tools, or our other
methodologies and pull-through possibilities. Please contact your Ogilvy
CommonHealth representative, or Ashli Sherman, Vice President of
Client Services, Ogilvy CommonHealth Behavioral Insights, at 973-352-
2186 or ashli.sherman@ogilvy.com.
Written by Katy Hewett, Research Manager, Ogilvy CommonHealth
Behavioral Insights
References
1. Coupland N, Jaworski A. Introduction. In: Coupland N, Jaworski A,
editors. Sociolinguistics: A Reader and Coursebook. Hampshire,
Great Britain: Palgrave; 1997. p. 1-3.
2. Hahn SR, Lipton RB, Sheftell FD et al. Healthcare provider-patient
communication and migraine assessment: results of the American
Migraine Communication Study, phase II. Curr Med Res Opin 2008
June; 24(6):1711-8.
Note: All dialogue examples are similar to those that would be
found in real in-office communication.

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Top 7 Insights from Years of Observing Real-world Healthcare Communication

  • 1. Top 7 Insights from Years of Observing Real-world Healthcare Communication June 2016
  • 2. 2 With all of the changes in the healthcare industry over the past several years, patients and healthcare providers are feeling more pressure than ever to seek and deliver effective care. The healthcare universe is broad and ever-changing, with many outlets for learning, sharing, and supporting others. However, one thing has not changed—the foundation of healthcare is communication. What is said (or not said) during office visits, and how it is said, play a critical role in the success of patient care. Successful communication is the key, but so often there are misunderstandings and missed opportunities. Sociolinguistics is the study of language use in society, and the study of society through the lens of language. It is a broad interdisciplinary field with many traditions of study, providing the tools to analyze the various forms of healthcare communication.1 Discourse analysis, interactional sociolinguistics, ethnography of communication—these are only a few of the traditions of study, each with its own techniques, that can not only shed light on what patients, healthcare providers, and others are saying, but also on how, why, and what it means. For pharmaceutical brands and the healthcare industry, this is paramount. Over the past 15 years, the Ogilvy CommonHealth Behavioral Insights team has used sociolinguistic techniques to study and improve healthcare communication. We spearheaded this research by studying dialogues between patients and healthcare providers using our proprietary methodology, which allows us to observe real-world office visits, through unobtrusive video- and audio-recording, and compare what is said with what providers and patients take away. We conduct post-visit interviews that are structured to gauge alignment and are tailored to specific category and brand needs. This research is IRB-approved and HIPAA-compliant, which has enabled us to produce over 50 peer- reviewed publications in primary healthcare journals, posters, and presentations at national congresses. We have also applied the insights gained from this research in the creation of patient education materials, dialogue guides, and other tools to enhance care. Recruit physicians who then identify appropriate patients Record office visits Interview physicians and patients separately after their visits Analyze dialogue and triangulate results Ogilvy CommonHealth Behavioral Insights Managing the Dialogue® In-office Linguistic Research
  • 3. 3 In recent years, we have expanded our research and have developed methodologies that study healthcare communication outside of the exam room, providing a 360° understanding in a given healthcare category:  Social Monitoring and Insights: We listen to what is being said online and apply sociolinguistic techniques to identify behavioral insights, going beyond traditional social listening research. Studying what patients, caregivers, and others are sharing online in a category provides important insight into their experience and needs.  Computational Lexical Analysis: Combining big data analytics with human interpretation, we study the language and linguistic trends being used in peer-to-peer literature surrounding a brand to provide recommendations for a strong brand lexicon— ensuring that the words and phrases used to describe the clinical story are accurate, differentiating, ownable, sustainable, and evocative.  Day-in-the-Life Ethnography: We observe patients and caregivers during their daily life to understand their disease experience and then perform in-depth motivational interviews to learn about their journey, uncover their beliefs and rationale, and identify disconnects between what they do and what they say they do.
  • 4. 4 56% 32% 12% Average Percentage of Words Spoken by Participants During Office Visits Physician Patient Others (e.g. visit companion, nurse, medical assistant) Through our research observing healthcare communication, we have discovered some pervasive trends and insights: 1. Physicians dominate the office visit discussion. Physicians speak an average of almost 60% of the words during office visits.
  • 5. 5 2. Physicians typically ask questions that restrict patient answers. Physicians often ask closed-ended and short-answer questions rather than open-ended questions that would allow patients to add new information and perspective that they may not have shared otherwise. Note: All dialogue examples are similar to those that would be found in real in-office communication.
  • 6. 6 3. Patients often take a backseat in the visit discussion. During office visits, patients often assume that physicians will let them know everything that they need to know and ask them for any important information. However, they are often left without answers, or with more questions. More and more patients and caregivers are going online to educate themselves and to participate in online communities, having discussions, sharing information, and supporting each other, but they are not always bringing this initiative to their interactions with healthcare professionals. In this age of patient health literacy and advocacy, when patients are being expected to take more responsibility for their own healthcare choices, it is important that patients apply that principle during visits with their physicians, asking questions and volunteering information that they think is important, even if the physician does not ask.
  • 7. 7 4. Quality of life impacts are typically overlooked. Physicians rarely ask patients about the impacts of their condition on their quality of life. We often hear this is because physicians are pressed for time and assume patients will tell them about quality of life impacts if they are significant. Patients often do not bring it up because they do not think the physician wants or needs to hear about it—they view it as their personal struggle. Also, certain diseases that significantly impact quality of life can be embarrassing for patients to discuss with their physician. This dynamic can be particularly detrimental in conditions that significantly impact quality of life, such as respiratory conditions including asthma and COPD, as well as overactive bladder. With overactive bladder, the condition can be easily disregarded and go undertreated. Patients with overactive bladder are often unable to do activities that they used to do, because they need to be near a restroom at all times. This is especially true if they experience incontinence, and need to wear pads or diapers, which can also be embarrassing. However, many patients do not share these impacts with their physician, because they are embarrassed due to the stigma or believe this is a normal part of aging.
  • 8. 8 5. Treatment goals are rarely discussed. Physicians rarely discuss treatment goals with patients, and if they do, they are often vague and difficult to benchmark. Patients assume that they know the treatment goals and are aligned with their physician. We have seen this dynamic play out in visits with physicians and patients who have a variety of conditions, including insomnia and ulcerative colitis. Patients with ulcerative colitis view treatment success as clinical remission, or lack of symptoms. However, physicians define it as both clinical remission and endoscopic remission, or lack of inflammation in the colon. Thus, once patients reach clinical remission, they believe they have achieved the goal of treatment and may not understand why further or more intensive therapy may be necessary.
  • 9. 9 6. Diagnosis of terminal conditions is often unclear and patients are left unaware. If they do not see therapeutic benefit, physicians do not always clearly communicate a terminal diagnosis to patients, because they want to “first do no harm.” Unfortunately, this can be ultimately harmful to patients and their loved ones, because they may not have the same opportunity that they would have had to plan for the future. Patients often assume that physicians would share a diagnosis with them if there was one to be shared. We have seen this dynamic play out in visits with physicians and patients who have a variety of conditions, such as metastatic breast cancer and Alzheimer’s disease. Since Alzheimer’s disease causes a loss of identity and is thus perceived as a form of death in American society, it is a taboo subject surrounded by euphemism and avoidance. Without treatments that make a significant difference, physicians often do not see any benefit in explicitly telling patients that they have been diagnosed with Alzheimer’s disease, but instead speak around it, referring to the patient’s condition as “memory” and other vague terms. Patients assume that if the physician had diagnosed their symptoms, they would have told them. Thus, patients assume that their symptoms are caused by normal aging, and they do not get the same opportunity they may have had to make plans for their inevitable decline.
  • 10. 10 7. Poor communication leads to poor outcomes, and good communication does not have to take more time. Misunderstandings ultimately result in patients not getting the care they need from physicians, such as not being prescribed treatments that could help them, and patients not being adherent to treatments that they are prescribed. For instance, in the case of overactive bladder, there are many medications and lifestyle interventions that could help patients, but with physicians underestimating the impacts on quality of life, they are complacent about changing patients’ treatment. In the case of ulcerative colitis, patients are often nonadherent to treatment because they do not understand that the goals for treatment go beyond what they can observe—when their symptoms recede, they believe they have achieved success, which is unfortunately not always the case. Our research has shown that the addition of an open-ended question does not have to lengthen the visit. In fact, it may shorten it, and it provides key information that leads to more physician-patient alignment post-visit and patients ultimately receiving appropriate treatment. In the first phase of a two-phase interventional study on the communication between physicians and migraine patients, we found that physicians use closed-ended questions to assess migraine symptoms, focusing on frequency and paying little attention to impairment—leading to physicians underestimating impairment when asked post-visit and resulting in patients being deemed as “not needing prevention.” During the intervention, physicians were trained to ask one open-ended question about impairment, “How do your migraines affect your daily life?” In the second phase of the research, we found that by physicians asking this open-ended question, it gave patients the opportunity to tell their story—without significant time spent (median 9:36 versus 11 minutes)—and compared with baseline, significant improvement was observed in frequency of discussion and prescription of preventive therapy, physician and patient satisfaction, and alignment on impairment and frequency between physicians and patients.2
  • 11. 11 Conclusions Physicians are the experts in medicine, but patients are the experts in their own experiences. Communication is a two-way street and nowhere is this more important than during an office visit—this is the backbone of patient-centered care and shared decision-making. We must incite behavior change to improve healthcare communication. Every therapeutic category and condition is unique. We can help you to first understand the dialogue and then to impact communication in your category in various ways:  Dialogue tools to guide visit discussions  Educational materials for patients  Physician training programs  Advisory boards engaging key opinion leaders  Primary publications  Posters and podium presentations at conferences  Public relations materials This is just an overview, so if you want to talk about conducting physician-patient in-office communication research, online social monitoring, how best to promote your brand using patient-education materials and dialogue tools, or our other methodologies and pull- through possibilities, we are just the team to help. Additional Answers Ogilvy CommonHealth Behavioral Insights will gladly answer any questions you have pertaining to this document or to any topics involving physician-patient in-office communication, online social monitoring of patients and caregivers, how best to promote your brand using patient-education materials and dialogue tools, or our other methodologies and pull-through possibilities. Please contact your Ogilvy CommonHealth representative, or Ashli Sherman, Vice President of Client Services, Ogilvy CommonHealth Behavioral Insights, at 973-352- 2186 or ashli.sherman@ogilvy.com. Written by Katy Hewett, Research Manager, Ogilvy CommonHealth Behavioral Insights References 1. Coupland N, Jaworski A. Introduction. In: Coupland N, Jaworski A, editors. Sociolinguistics: A Reader and Coursebook. Hampshire, Great Britain: Palgrave; 1997. p. 1-3. 2. Hahn SR, Lipton RB, Sheftell FD et al. Healthcare provider-patient communication and migraine assessment: results of the American Migraine Communication Study, phase II. Curr Med Res Opin 2008 June; 24(6):1711-8. Note: All dialogue examples are similar to those that would be found in real in-office communication.