Evolution Consulting amp Research May 2016 2 Why Look into the Role of Physicians Emotions in their Prescribing Decisions Do doctors even feel emotions Arent doctors just consumers in labcoats ID: 556617
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Slide1
How Physicians Use Emotion When Making Prescribing Decisions
Evolution Consulting & Research
May, 2016Slide2
2
Why Look into the Role of Physicians’ Emotions in their Prescribing Decisions?
Do doctors even feel emotions?
Aren’t doctors just consumers in lab-coats?
Shouldn’t we strive to make physicians feel happy and confident in their decisions?
Can’t we just take the mounds of data regarding the role of emotions in consumer purchasing behaviors and bootstrap them to physicians’ medical decisions?
Why are physicians universally uncomfortable when participating in research that has an emotive component?Slide3
I know, the list we provided was
not very good, and we were late providing you with feedback, yet we will still need to move the deadline
for deliverables up by 2 weeks
due to our internal schedule.
Hey! You skipped lunch. Now, I’m
gonna
start growling
Ooo
, this low blood sugar is giving me a headacheSlide4Slide5
Angry
Emotion
Affect:
Emotion:
Transitory but intense
Has a specific cause leading to physical response
Emoter has personal stake in event
Leads to an action/coping mechanism
Not stored in long-term memory
Mood:
Non-intentional
No distinct causal effect
Does not lead to an action
Attitude:
Enduring
Evaluative judgement based on emotion, mood, and cognitive processing
Stored in long-term memory
Negative
Attitude
Sour
Mood
Affect:
Mental process that includes emotion, mood, and attitudes
PRIMARY
SECONDARYSlide6
“
Oooo
, ice cream!”
“Reminds me of Summer…”
“…and picnics!”
“What a wonderful time we had !”
“I
gotta
buy that ice cream!”
Ice Cream = Happiness
“Grumble, grumble.”Slide7
Primary Emotions:
Innate (genetically driven)
Leads to Reactive Responses (e.g., “Fight or Flight Response”)
Driven by
p
rimitive areas of the brain:
Limbic System
Amygdala
Anterior Cingulate
PRIMARY & SECONDARY EMOTIONSSlide8
Secondary Emotions:
Learned (via personal Experience)
Formed through associations between primary emotions and actions, objects, and situations
Leads to anticipatory response
Driven by higher-order areas of the brain:
Pre-frontal cortex
Somatosensory cortexSlide9
Evidence-based Medicine (EBM)
Naturalistic Decision Making (NDM)
Classical Decision Theory (CDT)
Maximizing expected value & using information in an optimal fashion
Using the best, most current evidence in medical decisions
Making medical decisions under sub-optimal conditions
Choice of Options
Beliefs
Perceived Consequences
History of Medical Decision-Making Theories:Slide10
Process Decisions
Making decisions in a step-wise fashion
Choice of Options
Beliefs
Perceived Consequences
Heuristics
Medical Decision
Outcome Evaluation
Positive
Negative
Evaluate & Revise
Reinforce & Proceed
Factors Guiding Process Decisions:Slide11
Heuristics
Decision
Evaluate
DIAGNOSIS
Heuristics
Decision
Evaluate
PREVENT RECURRENCE
An Example Process Decision:
Heuristics
Decision
Evaluate
ALLEVIATE SYMPTOMS
+
Diagnosis is correct – Proceed
–
Diagnosis is incorrect – Adjust course, re-evaluate diagnosis
+
Tx
is correct – Proceed
–
Treatment did Not Resolve Symptoms – Adjust course, re-evaluate
Dx
, switch treatment
+
Tx
is correct – Monitor
–
Treatment did Not Prevent Recurrence – Adjust course, re-evaluate
Dx
, switch treatmentSlide12
Factors Impacting Decision Process
Complex
Task Complexity
Level of Expertise
Perceptions of Risk
Directionality of Decision
Simple
Novice
Expert (KOL)
High
Low
Backward Reasoning
Forward Reasoning
Levels of Decisions
Level 1
Level 2
Level 3
Level 4
Quick & habitual
Mapping attractiveness of alternatives
Within alternative conflicts and/or few/no attractive alternatives
New/unfamiliar problem requiring new decision alternativesDependence on Heuristics
High
High-Mod
Mod-Low
Low/No
Cognitive Effort Required to Make Medical Decision
Low
HighSlide13
Consumer
Healthcare
Provider
Patient
Nurses
Pharmacists
Payors
Caregiver
Hospital
Society
HCP’s
Family
Spouse
Child
Retailer
Co-workers
Supervisor
Neighbor
Society
Friends
Impact/Implications of Decisions:Slide14
14
Process Decisions
Making decisions in a step-wise fashion
Choice of Options
Beliefs
Perceived Consequences
Heuristics
Medical Decision
Outcome Evaluation
Positive
Negative
Reinforce & Proceed
Evaluate & Revise
Re-evaluation of situation, decision, action:
Mitigate emotional impact:
Remove or undo harm/barrier to the goal
Obtaining help or support in achieving the goal
Decreasing desirability of the goal
Reevaluating the goal
Redoubling effort
Recognize gap in knowledgebase
Attribute poor outcome to patient neglect/failing to assume responsibility for outcome achievement
Attribute poor outcome to group-think, poor guidelines, over-reliance on EMRSlide15
15
Robert
Plutchik’s
Wheel of Emotion:
Regret
Shame
Pride
Satis
-factionSlide16
16
Decision = A
Outcome = Expected
Outcome = Unexpected
Evaluation:
Heuristics used to make Decision A have been
validated
.
Situation = A
Evaluation:
Heuristics used to make Decision A have been invalidated. Remove or undo harm/barrier to the goalObtaining help or support in achieving the goalDecreasing desirability of the goalReevaluating the goalRedoubling effort
Recognize gap in knowledgebase
Attribute poor outcome to patient neglect/failing to assume responsibility for outcome achievementAttribute poor outcome to group-think, poor guidelines, over-reliance on EMR
Tx Goal = A
Odds of making Decision A increases for the next appearance of Situation A
Re-evaluation of situation, decision, action:
Mitigate emotional impact:
One or both evaluative steps are taken
Odds of making Decision A
decreases
for the next appearance of Situation A
Positive Emotional Response
(satisfaction, self-fulfillment)
Negative Emotional Response
(embarrassment, regret, shame)
Process Decision
(expanded)Slide17
17
Consumers’ versus Physicians’ Use of Emotion:
Consumers
Physicians
Consequences of a purchasing decision are limited
Consequences of a medical decision are wide-reaching
A
positive
emotional
response has a significant influence on a consumer’s future actionsA positive emotional response has a tempered influence on a physician’s future actions
A
negative emotional response has a significant influence on a consumer’s future actions
A negative emotional response has a significant influence on a physician’s
future actionsRisk-aversion is highly dependent on context and is dependent on the strength of the emotional response to prior negative outcomes
Risk-aversion is the rule, rather than considered on an individual basisSlide18
18
Physicians
use emotions as a way to gauge the appropriateness of their decisions and to build (or validate) heuristics, whereas consumers often see an emotional response as the end-goal of a decision.
For physicians, regret avoidance is the most motivating emotion due to the wide consequences of poor decisions and negative outcomes. As such, feelings of regret will often lead to immediate changes in a prescribed treatment plan.
Positive
emotions, while often linked to good decision making, have less immediate impact on a physician’s actions, but instead have a cumulative effect (through experience).
Unlike physicians, consumers place less weight on future outcomes than they do on immediate
outcomes.
The
majority of decisions made by consumers on a day-by-day basis are low-level (Level 1-2), whereas the majority of clinical decisions made by physicians are high-level (Level 3-4) that require much more analytical scrutiny; there is simply less room for
emotions. Finally, group medical decisions further diminish the influence of any one physician’s personal emotional/mood state on the decisions being made. ConclusionsSlide19
19
So, what does this all mean?
Outcome of Medical Decision
Positive (Pride, Self-satisfaction)
Negative (Shame, Embarrassment)
Negative (Regret, Humiliation)
0%
10%
20%
30%
40%
50%
60%
70%
8
0%
9
0%
100%
T0
T1
T2
T3
T4
T5
T6
T7
T8
Odds of Choosing DrugSlide20
20
So, what does this all mean?
Help medical marketers, manufacturers, and advertising agencies with actionable insights to develop communications that will motivate physicians;
Clarify the rift between consumer-based
and
healthcare-provider-based decision
processes
and provide insights on how
to
more effectively communicate with these diverse target audiences;Provide healthcare professionals with data to help them better assess the riskiness of their decisions, the impact of their decisions on patients, and insights on how to better communicate their therapeutic goals and concerns.Slide21
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John
Taenzler, Ph.D.
Principal
267.405.8050
For a full description of our experience and service please visit us at
evolutionconsulting.com