Understanding the hidden depths of doctors’ decision making

By Elise Roche, Managing Partner, Day One Strategy

Have you ever wondered what truly motivates and drives doctors? What factors lie behind the choices they make? These questions have long vexed pharma marketers, as they strive to understand the Holy Grail of marketing in the medical field. However, for many pharma marketing teams, this understanding can often feel out of reach.

There seems to be a prevailing belief that if the clinical data for a drug is strong, doctors will inevitably choose to use it. It’s assumed that science alone should provide a sufficiently convincing argument. But the reality is far more complex. So, what’s really going on here?

All too often, we forget that doctors are humans too. We place unrealistic expectations on them, assuming they will make flawless treatment decisions based on perfect patient profiles, with complete knowledge of every new piece of information available. We expect them to make purely rational choices guided by cold, hard facts. However, this is far from the truth. Like all humans, doctors are driven by deep, hidden emotions that inevitably come into play when making prescribing decisions. These emotions can be influenced by a multitude of factors, including personal beliefs, experiences, biases, and the relationships they have with their patients and colleagues.

In this enlightening article, Elise Roche, Partner at Day One, engages in a conversation with Julie Jensen, Director at The Hidden Depth, as they shed light on a recent research project they collaborated on. Together, they embarked on a mission to uncover the deepest desires of oncologists, utilising the innovative Hidden Depth Method—a structured framework of research and analysis designed to explore the three layers of human reasoning and their interplay: the self-reflective, symbolic, and unconscious.

To start, I’d love to hear a bit about your background and the journey that led you to the hidden depth method.

I began my career 30 years ago at Intel, defining and designing technology products. Later, I shifted into product and industrial design, researching a wide range of subjects from chocolate to transit vans to insulin injectors.

As CEO of a design strategy consultancy, I became a client of the Hidden Depth. It’s such a powerful tool for informing strategic decisions, going beyond the functional and rational benefits of products. This direct experience of using the methodology led me to join the Hidden Depth team as a Director.

My expertise lies in how language and communication systems shape emotions and behaviour. I also lecture in design research at Central Saint Martins, where I tutor Master’s students. Over the years, industrial design has evolved beyond three-dimensional products, now encompassing service design, system design, and the application of design methods and research to address complex societal issues.

Thinking specifically about marketers, why do they need a different approach to uncover the emotions and motivations of their customers?

Neuroscience has established that most of our cognition and decision-making occurs beneath our conscious awareness. If your marketing, communication, and product strategy solely relies on what people say or what you observe them doing, you miss out on the deeper emotions, mental models, cultural influences, symbolism, and understanding that truly drive behaviour.

This is where the Hidden Depth method becomes invaluable for marketers. By combining tools and techniques from various schools of thought such as depth psychology, semiotics, linguistics, neuroscience, and behavioural economics, it helps marketers make sense of human behaviour that might not be obvious.

The key question becomes: Why aren’t people behaving or doing what you expect or want them to do? This lies at the heart of marketing—persuading people to take desired actions.

Why is the hidden depth method particularly useful in tackling healthcare challenges?

Healthcare presents a heightened version of these challenges. Research has shown that people don’t act as rationally as expected when it comes to health and wellness. Traditional behavioural approaches often fall short.

In the healthcare domain, there are numerous perplexing questions to address: Why do people consume unhealthy food and drinks beyond the point of pleasure? Why do they neglect to take a beneficial medication? Why are doctors reluctant to prescribe proven treatments? Most research techniques struggle to effectively grapple with these questions.

However, the Hidden Depth method excels in this area, especially due to its sensitivity. We often engage with individuals who are seriously ill, nearing the end of their lives, and doctors under immense pressure. Topics such as shame, addiction, and poverty are difficult for people to open up about in traditional focus groups or one-hour interviews. By spending two and a half to three hours with participants, over multiple touchpoints, we can delve into areas that traditional research methods fail to reach.

Day one recently completed a pilot project with the hidden depth to uncover the deepest desires of oncologists. Could you provide an overview of this research?

With Day One, we conducted Hidden Depth interviews with eight oncologists in the UK. It’s interesting because many people assume that the motivation of all doctors is obvious — they save lives, right? However, what we have discovered over the years is that each specialty attracts different types of people who acquire unique paradigms, mindsets, tools, and ways of navigating the world. This creates a shared culture within each specialty, shaping their emotions, understanding of the world, and driving different issues and fears. So, we expected oncologist to be different from other doctors. The most surprising finding with oncologists was HOW different they were from other doctors.

What sets oncologists apart from other specialties?

The dynamic between oncologists and patients was a significant finding in our study. In many specialties, patients who conduct their own research and bring alternative treatments into the consulting room are seen as problematic, leading to anger and frustration on the part of the physician. However, what we found with oncologists is that this is rarely a problem for them. For example, oncologists often have patients refuse treatments, including patients who have good chances of long survival rates with conventional approaches. Instead, they may choose to follow the advice of a naturopath or even a psychic. While oncologists may not agree with the decisions patients make, and will make their case for their own recommendations, they really respect that these choices are very subjective and individual.

How can marketers leverage this knowledge? For example, do you think oncologists would be open to conversations about the patient perspective in oncology?

Oncologists are highly attuned to the patient perspective, and they treat each patient individually. They excel at understanding and speaking the language of their patients. It’s essential for pharmaceutical companies to also demonstrate an understanding of what matters to patients, because that’s what matters to oncologists. They shouldn’t be afraid to take conversations beyond clinical evidence and delve into the meaning of a patient’s life and how they choose to live it.

Based on this project, what are the three key pieces of advice you would give on communicating with doctors about oncology treatments?

First, it’s important to understand that your treatment is just one part of a complex conversation between an oncologist and a patient. Be aware of the context in which your treatment is being discussed.

Second, it’s not solely about giving a patient more time or improving their quality of life; it’s about the meaning of that life. For example, some people will sacrifice their own quality of life to provide emotional peace for their families. Because that’s where they find meaning.

Third, recognise the system-wide pressures oncologists face. They are not only focused on providing the best care to each individual patient but also on delivering the best care to the greatest number of people. These treatments are often costly, so it’s crucial to consider how to enable oncologists to help the most patients, as that is important to them.

We often receive questions about whether busy doctors are willing to participate in lengthy interviews and why they agree to take part. What feedback have you received from doctors?

Participating in a Hidden Depth interview is one of the few opportunities in a clinician’s life where they can reflect on their own human experience and be acknowledged as individuals. It allows them to step outside their usual way of thinking, leaving them feeling energised and refreshed. This is a valuable by-product of what we do – we’re getting a lot of insight from the doctors, but we’re also giving something back to them.