Dialogue with a KOL
Scientific exchange in the MSL role is not the same as having a chat with a colleague about an exciting new data point. Most pharmaceutical companies employ teams of MSLs to discuss scientific and clinical information with healthcare providers. The team members are considered subject matter experts (SMEs) in the field they support. The role assumes that the MSL can translate complex technical information to various audiences – using acronyms with some and not with others, for example.
Some MSLs bring prior experience to the role from industry or academia that assist them in knowing the influencers in the therapeutic area even if there is no personal relationship. Those prior experiences may not have prepared the MSL to build strong relationships with healthcare providers through conversation and dialogue. MSLs without a long history of working with KOLs may presume that their conversations in the field are like those they had with colleagues in the lab.
Dialogue is not Debate
Scientific debates are, at times, passionate and loud. In general, MSLs should not be treating the healthcare providers in their territory as if they are colleagues who can argue a point of theory in a bit of fun. The linguistic style of a KOL meeting is not the same. Not fully grasping the parameters of the MSL role in scientific exchange can impact the MSL’s performance in the field. In severe cases, the lack of strong field relationships can impact the organization due to the loss of opportunities and additional outputs. Forbes recently cited the cost of poor communication in business as $37 billion per year [1]. Yes, billion. So, how does an MSL create a conversation that is interesting, lively, and valuable to all parties involved?
JUST THREE THINGS
If you take away just three things from this blog posting it would be:
Professionals presume that they are strong communicators. We all tend to assume our communication style is logical [2]. Studies suggest adults spend 70-80% of their time communicating in some way [3]. If that’s true, how can we be poor communicators? Wouldn’t someone tell us? Probably not. We all need to improve our communication skills!
PLANNING FOR THE MEETING IS KEY
Planning is an essential activity to succeed in life. People plan for babies, weddings, and medical procedures, but many MSLs do not adequately plan for their KOL meetings. Effective MSLs identify areas for discussion prior to setting up the appointment even if the topics are revised prior to the appointment. It is common, however, for MSLs to be resistant to the notion of thinking about what data or scientific topics would provide value to the KOL.
Common Responses to Planning for KOL Meetings
‘I can’t predict what the KOL will want to talk about today,’ they say. What about what the MSL needs to discuss? The MSL provides value to the KOL but the MSL (as a liaison) also brings valuable information and value to internal stakeholders in the organization regarding treatment decisions in the real world.
‘It is best not to put that in the email,’ they say. Why would a busy professional want to block time out of their schedule for an unknown reason? However, the MSL reaches out the KOL to set up the appointment, there must be some reason beyond ‘catching up’. MSL time is valuable, as is that of the healthcare provider.
‘I know this data really well, I can talk about anything,’ some MSLs confidently state. Sure, but is the conversation going to be scattershot or organized? Has the MSL thought through the data lately? Done some recent literature searches? Practiced the delivery of the content in a small office while you carefully balance the tablet on a stack of journals in plastic sleeves?
Priority Areas for KOL Discussion
Even if MSLs choose to send a generic and vague email to set up a meeting, they should have planned the priority areas they would like to cover during the meeting. The plan can be a simple list of three data points, articles, or disease state topics they plan to touch on during the meeting. The list should be short – it is not meant to be a laundry list of everything the MSL could ask. A good meeting full of mutually beneficial scientific exchange will likely only touch on three to four topics.
During the year, the MSL may find that certain topics generate a lot of discussions while others don’t. That is useful information to know and it allows the MSLs to evaluate other topics for discussion. At times, the management team defines the objectives, but MSLs provide internal value by indicating areas of KOL interest.
VALUE PROVIDED TO THE KOL
Most teams maintain a list of key data areas around which they would like feedback. That is a great place to focus your attention.
As MSLs build KOL relationships, they become aware of interests or experiences. If KOLs are interested in a topic, talking about is in a meeting shows that the MSL is interested in similar data – a great rapport builder.
- Is there new data on the topic?
- A new poster or abstract presented at a meeting?
- Does the MSL have complex or esoteric questions on the topic?
During a conversation, if you are making the other party think about their position or how the data impacts their practice, you have created value. Helping someone learn something new, creating a richer context, or adding to an existing paradigm are all significant benefits of scientific exchange.
It is also essential to identify the KOL’s agenda. The MSL may be so excited to discuss the data that they fail to gain the KOL’s agreement of the topics for discussion at the beginning of the visit. Also, the KOL may have topics that they would like to discuss with the MSL. By missing the opportunity to identify the KOL’s agenda, either situation can dampen the KOL’s enthusiasm to continue the meeting.
How to get the conversation going? Ask an open-ended question. Intentionally using open-ended questions helps draw out information and encourages more complex answers. Listen carefully to the response and ask a follow-up question or pick up on something the KOL shared. During a conversation, it is not necessary to ask only open-ended questions, especially when clarification is required. MSL questions should allow the KOL space to express themselves.
If the MSL has not prepared to respond to the various responses the KOL may make, the conversation may suffer. The MSL may not be able to dig deep enough to uncover motivators and the HCP’s true opinions and thoughts. Remember, HCPs have many people come through their doors to discuss the data who are happy with surface answers. MSLs, on the other hand, are expected to know the data deeply and be fluent enough with those data to push for a more thoughtful response.
PREPARE TO LISTEN TO THE KOL
A study regarding clinical encounters found that in a random sample of 112 clinical encounters physicians interrupted the patient after a median of 11 seconds [4]. It’s not just physicians. Many people are too quick to jump in with a response that fails to let the other party complete their thought.
In specific contexts, jumping in can be perceived as helpful. This is true in situations of ritual opposition – a conversational style that can work if everyone understands it is meant as an exploration of a topic through the practice of verbal opposition [2]. Think back to a past work meeting in which you participated. Defending an idea provides an opportunity to test it. The conversation partner may play devil’s advocate to explore and test ideas. It may sound like a loud argument, but an hour later it is all forgotten. Some KOLs may love the verbal sparring, but an MSL cannot assume that is an appropriate interaction style. If MSLs find themselves talking over the KOL multiple times during the same conversation, and the KOL begins to shut down, then a reset is in order.
MSLs Learn A Lot Using Silence
In most instances of quality scientific exchange, the person who speaks least obtains the most information from the other party [6]. Some communication coaches recommend that the MSL should be silent for 80% of the conversation [7]. The MSL answers the questions the KOL has but also obtains knowledge about the provider’s perspective, ideas, theories, and challenges. Sometimes, taking that breath leads the provider to share information that they had not planned to share. Those insights are valuable.
Striving to not make assumptions about the physician should be top on the MSL’s To-Do List.
Assumptions about treatment considerations, challenges, and philosophies can cause the MSL to miss the opportunity to learn the physician’s thoughts. Those ideas and ruminations are a vital part of
Listening carefully to the physician has multiple benefits:
- It provides value to the physician. Most people enjoy the experience of people listening to them. Actively listening to the physician is an easy and effective method to provide value. Pulling out one thing that they touch on and asking for an additional explanation can make you a rock star in their book.
- It prevents an MSL from speaking thoughtlessly. Maybe the physician hit a personal trigger. Perhaps the topic is something that the MSL has not studied in a while. Sometimes, MSLs share information that they wished they had not.
- It creates a space fora real discussion built on respect. People tend to listen more closely to someone that does not grab the spotlight. Think of a colleague that doesn’t say much – but when they do everyone takes note. The MSL should strive to understand the physician paradigm and how various datapoints feed into it. If the MSL is having a rapid-fire discussion, a lot of ground may be covered but it will not likely lead to deep insights.
VISIBLE PERFORMANCE METRICS
Metrics in Medical Affairs are a touchy subject. MSLs do not want to be required to visit a specific number of physicians each quarter, but most MSL activities completed in private 1:1 conversation with KOLs. Quantifying interaction data of any kind is a surface value that may not fully capture an MSL team’s impact on the business.
So, can the value of the MSL be measured based on the impact they generate across customers, access, value discussions, and R&D [8]? If an MSL brings in insights that lead to a change in the TPP (target product profile) for a new pipeline drug, that is a huge deal. When an MSL notifies the organization of a previously unrecognized side effect, it provides time for the organization time to act and provide a solution. That is a tremendous return on investment.
MSLs create impact at the organization level by the significance of the conversations they are having in the field.
ACTION ITEMS FOR THE FUTURE
Understanding the physician’s concerns and interests provides the MSL with plenty of options for future appointments. Information or data not shared in the current visit can always be a topic in the future.
During some conversations, an MSL may agree to forward an article, citation, slide, or slide deck. ‘Great!’ says the physician. The MSL leaves the office and promptly moves on to the next appointment. The item never gets sent. What a lost opportunity! If an MSL does not have a memory like a steel trap, they would be wise to keep something on hand for the quick note. The response to the physician should be quick and complete.
Some discussions do not come to a natural close before the allocated time ends. In this case, the MSL has a clear action item to follow-up with the physician: to continue the conversation. Sooner rather than later is best. To maximize efficiency, the MSL should get it on the calendar before leaving the office.
Listen for KOL Challenges
The MSL should be listening for barriers or challenges for the KOL. Learn to recognize pain points – even when physicians do not describe them as such. These are another great thing to make note of during the meeting. Following the meeting, the MSL can take that as an action item for further investigation. Are other physicians in the territory (or nationally) experiencing similar issues? If the MSL can return to the office with an update of some kind (a journal article, validation of the concern, an idea, a solution), then the MSL has demonstrated the value of Medical Affairs.
ITERATION AND IMPROVEMENT
Entering into a conversation on a similar topic multiple times allows the MSL to fine tune their delivery and ask better questions. This process of iteration and practice works across all disciplines and the art of conversation is no different.
Across KOLs, the MSL team and individual MSLs should have some consistency in the topics they discuss. Within this scope, great MSLs can quickly sift through available data to produce customized information for the physician and their practice. Practice with the data and careful thought about how data relates to other data is critical in this process.
The information various stakeholders can provide to the MSL varies. Having appointments across the spectrum of professionals – from allied health to non-specialists to specialists to basic scientists – assists the MSL in honing their conversational craft. In turn, this helps excellent MSLs differentiate the medical information each stakeholder receives.
The MSL team leads the organization’s response to the continually changing medical environment and can become a differentiator and sustainable competitive advantage. The Boston Consulting Group (BCG) raised this possibility in 2013 [8], and it is even more credible in today’s marketplace.
BENEFITS BEYOND THE KOL
Effective communication is key to the individual, team, and organization. Meeting planning goes beyond an MSL-KOL interaction. Managers and MSLs should be planning for conversations with each other. Medical Directors should plan for meetings with other stakeholders. Areas where careful planning would be useful also include:
- Performance discussions
- Salary discussions
- Feedback discussions
- Pitching an idea
- Providing a report
Thinking about the key priorities of the conversation – how the discussion may flow; what data may be needed; common areas of concern – prepare MSLs to have a valuable and productive conversation that moves the discussion forward in a meaningful manner.
TEAM HUDDLE
An MSL team may benefit from an interactive workshop to discuss these ideas and work on context-specific issues.
We recently worked with a company to help the MSL team use their scientific objectives more efficiently at KOL visits.
For more information on how the workshop was constructed go here. It may provide value for your team as well.
REFERENCES:
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2.Tannen, D., The Power of Talk: Who Gets Heard and Why, in Harvard Business Review. 1995, Harvard Business Publishing.
3.Lee, D. and D. Hateshol. Listening: Our Most Used Communications Skill. [Posting] 1993 Oct [cited 2018 Oct 16]; Available from: https://extension2.missouri.edu/cm150.
4.Singh Ospina, N., et al., Eliciting the Patient’s Agenda-Secondary Analysis of Recorded Clinical Encounters. J Gen Intern Med, 2018. [Epub ahead of print].
5.Miller, K.E. A Simple and Powerful Technique for Better Listening. [webpage] 2018 Sept 21 [cited 2018 Sept 21]; Available from: https://www.psychologytoday.com/us/blog/the-refugee-experience/201809/simple-and-powerful-technique-better-listening?
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7.Farrell, W., Silence in Coaching, in Coaching with NLP. 2015.
8.Bloom, L. Raising the Bar in Biopharma Medical Affairs. [Report] 2013 Aug 20 [cited 2018 Oct 19]; Available from: https://invivo.pharmaintelligence.informa.com/IV123543/Moving-Medical-Affairs-To-The-Pharma-Forefront?vid=Pharma.