Beyond the rational mind: how emotions influence clinicians

Using new mix of approaches to find out what is really driving clinicians’ behaviour – by Jane Shirley, Mary Stewart and Paul Mannu of Cello Health Insight

Do you sometimes find yourself having driven home from work, and then realising later that you don’t remember anything about the journey?

You know you drove past all the usual landmarks along your route, and yet you can’t really recall seeing them. Somehow, one part of your brain was able to wander off onto other topics as you drove, whilst another part of the brain made sure you got home safely.

This is an everyday example of the often mysterious working of our minds and memory. These mysteries of our brain, and what we call our ‘consciousness’ are now being slowly uncovered by advances in neuroscience and other disciplines such as psychology. One of the most famous works to cross-over from the academic field into the bestsellers list was Thinking, Fast and Slow by Daniel Kahneman. Awarded a Nobel Prize in Economic Sciences for his research in psychology, Kahneman has challenged the common belief that humans are usually led by logical decision-making judgements.

The research of Kahneman and many others has made it quite clear: we are not as rational as we think we are.

This applies equally to the practice of medicine, even though this field, more than most, is meant to be evidence-based, scientific and rational.

Pharmaceutical marketers often puts healthcare professionals on a pedestal, and believe that they always use a rational approach in their work – but not every decision is applied or thought through as you’d expect. There is often a very strong human component determining how clinicians behave.

“We’re not always as rational as we think we are – and neither are doctors”

That means there is often a strong non-rational component to clinical decision-making – and this will be pertinent if we want to know why they are still prescribing a certain product, for instance, when there are drugs with superior efficacy or side-effect profiles on the market.

Getting past the filters

So how do you get to uncover and understand these emotions and non-rational drivers of behaviour when conducting market research in clinicians?

If you use direct questioning of doctors about their clinical decision-making, you will quickly find them rationalising their decisions.

There is also the well-recognised problem of ‘Good Doctor Syndrome’ in which doctors will give the answer they think they should – especially if it is in front of their peers in a market research group.

Clinicians will put these filters in place, but if you can create an environment where these rational defences can be bypassed – with their consent – then the level of insight can be much deeper.

So what techniques can you use to get to this greater understanding? We have assembled a multi-disciplinary team of researchers, bringing together people with expertise in different fields – neurolinguistic programming (NLP), systems theory, transactional analysis and gestalt psychotherapy. Twinned with insight into best practices in market research and understanding of healthcare, this is a very powerful combination.

The disciplines mentioned above may seem like a weird and wonderful collection, but all of them have proven their value in practical market research settings, to help uncover aspects of behaviour that would otherwise remain hidden.

We use a mix of different exercises based on these approaches to fit the objective of the research brief. Using these methods, the most honest and instinctive responses can be obtained from doctors – before their rational mind steps in and gives the answer they think you want to hear, or the answer they think they should give.


The invited group of doctors will be briefed and told: “We’ve brought you here to explore how you manage your renal dialysis patients,” for example, and then begin a series of group exercises.

One of the fundamental approaches is to create quite a high energy group – 5-7 doctors is an ideal number – and give them exercises which don’t allow them too much time to ponder their responses. These exercises most commonly involve writing, drawing, talking, using props and projecting ideas on to them, and movement. These exercises will engage all of their senses, and will generate lots of ideas and feelings. We want them to continue building on these insights, rather than pinning them down to give us a definitive answer.

These projects create a picture of the emotional landscape of the area under investigation, and will illuminate values, beliefs, motivations and restraints in their daily working lives. All these influence what treatments they prescribe and what clinical approaches they adopt.

The process can reveal habitual behaviours that the clinicians aren’t aware of.

“Neurolinguistic programming NLP can tell us whether someone is ‘Externally referenced’ or ‘Internally referenced”

We can use NLP to tell us whether someone is ‘Externally referenced’ or ‘Internally referenced’ An ‘Externally Referenced’ person is someone who will pay more attention to what other people think – so we might have one doctor who takes the views of budget holders to be an important influence on how they behave. In contrast, an ‘Internally Referenced’ colleague would be much more inclined to follow their own judgement and instincts on a given subject. Meanwhile the separate discipline of Transactional Analysis could help you understand the dynamic between a doctor and the patient, e.g. an ‘adult to adult’ dynamic produces a very different relationship and conversations to a ‘parent to child’ dynamic.

This is clearly going to influence how they behave in relation to the area we are researching, so at the end of the research, we can map all this data out to understand the system and influences within it.

Another technique we can use is mild trance and visualisation. That is one technique that people some time say ‘feels’ a bit like therapy, but isn’t. For us the aim is just the same – getting to the most honest and accurate picture of their clinical decision-making as possible.

You encourage them to get into a mild trance-like state and ask them to close their eyes, and evoke a real-like situation they have found themselves in at work.

They will be seeing it in their mind’s eye, and we will ask them to break down a process into little blocks. By doing this, we can start to understand in details many of the emotional drivers of behaviour, and from there begin to see how this behaviour might ultimately be influenced or changed.

Perspectives on patients

Another interesting approach is to ask doctors to think of a consultation with a typical patient or clinical situation using metaphors.

This approach captures beautifully how GPs feel when managing their patients. One memorable example of this was how a GP described an Alzheimer’s patient being like a vintage china cup – still intact, but then gradually accumulating cracks in the glaze, until eventually they shatter.

Another exercise would be a kind of role play, where you ask them to imagine that they are the doctor in a consultation in one minute – and then the patient the next.

The participant is asked to physically get up and sit on the other side of the desk. This is surprisingly effective in helping them take on the mantle of that person, and then get into the essence of the clinical questions and dilemmas.

Not surprisingly, participants often tell us that they have learnt something from the sessions that they will be able to reflect or act on.

Naturally we have also learnt a lot from all their insights over a two and half hour session, and these can be analysed and presented in various formats with a narrative overview, which can feed directly into planned sales and marketing activities such as a creative brief.

A leap of faith

While participating in these somewhat unconventional market research workshops requires the development of trust and rapport from the participants, it also demands a leap of faith from pharmaceutical marketers.

“The aim is to get past those standard answers that often emerge through conventional market research techniques”

This approach doesn’t involve putting the same number of direct questions to participants as conventional methods, but often delivers much richer results that are meaningful when differentiating your product.

Clinical and rational insights can be gleaned as well, of course, but they won’t take centre stage as they normally would. But by using this toolbox of approaches, a wealth of rich and revealing content is generated which is then systematically and rigorously analysed. The aim isn’t to find trends to match any pre-conceptions we might have had at the outset, but do get past these and the standard answers that often emerge through conventional market research techniques.

Taking a different approach means you can tease out emergent patterns which reflect how clinicians actually behave in real life, and reveal the mix of forces which really motivate them.


About the authors

Jane Shirley – CEO, Cello Health Europe; Joint CEO, Cello Health Insight

As CEO of Cello Health Europe and joint CEO of Cello Health Insight, Jane has played a crucial role in the development of Cello Health, bringing together the different capabilities. A seasoned international specialist, she has driven the extension of the international footprint with particular focus on developing the US market.

Jane has worked across a wide range of therapy areas and methodologies but holds a particular passion for more complex qualitative work, particularly assessing early stage opportunities.

Paul Mannu, Director, Cello Health Insight

Paul has over 30 years of healthcare research experience and has dedicated much of his work and academic focus on understanding behaviour. His academic background with individual degrees in nursing, economics, and psychology to masters level has focused on the traditional and more recent theories of understanding health behaviour. His current focus is on the role of behavioral economics in health and wellbeing and developing use of established methods of phenomonological, narrative and discursive enquiry to understand illness burden and how it can be measured.

Paul focuses on new approaches to communications and developing Insight’s Constellation Health Outcomes Service.

Mary Stewart, Director, Cello Health Insight

Mary is a qualified NLP practitioner with over 25 years of pharmaceutical industry experience, including 20 years working in market research on both the client and agency sides.

A qualitative researcher at heart, Mary has a keen interest in understanding what – at an out-of-conscious level – makes people think and behave the way they do. Identifying emotional and rational drivers of thinking and behaviour enables Mary to better understand engagement systems involving healthcare professionals, patients and carers.

Mary also has extensive experience working with sales and marketing teams to develop communications campaigns across a broad range of therapy areas.


Closing thought: Share your views on how to get the most from market research with healthcare professionals