SOAP: How Doctors Present Clinical Data to their Peers

In my last blog we learned that doctors need clinical data in order to make a decision to use your product.  All clinical studies are organized according to a template known as SOAP.  SOAP is a common template used by all healthcare professionals to present clinical information in a formatted and concise way.  It is also an easy way for doctors to present, understand, and remember clinical information.  SOAP is also used to create notes in a patient chart, general patient communication, presenting patient cases, diagnosing/treating patients, and presenting clinical studies.  Clinical studies are organized based on the SOAP template as described below. 

 1.  Subjective 

Subjective information in the study can be found in the introduction and background section of the abstract.  The subjective information includes the problem the study investigates.  Doctors solve clinical problems every day and will be looking for a problem that this study addresses.  They will find that information in the introduction or background sections of the study or study abstract. 

2.  Objective 

The objective information comes from the study design and outcome measures section of the study or study abstract.  The objective information builds credibility for the study by including data sources and detailed information about the author, and the journal where the study was published.  Objective information in a clinical study might include the author, the journal, date of publication, where the study was published, the number of patients, and whether it was random, double blind or placebo controlled.  It is this information that will help the doctor decide how much weight or credibility to place on the study.  If this information is strong, the doctor is more likely to alter their behavior and follow the actions of the study authors in hopes of getting the same outcome.

3.  Assessment

The results section of the clinical study or abstract assesses the outcome measures that solve the problem in the subjective statement.  This information is very important to doctors because it is an unbiased measurement of the product in the studies performance.  This section usually contains numbers and percentages, and can be very direct and to the point.      

4.  Plan

The author's conclusions or recommendations are found in the discussion or conclusion section of the study or abstract.  The author’s recommendations are listed in the Plan section of SOAP because it is where the authors give their recommendations similar to the way doctors recommend a treatment plan to patients in their office.  This statement is usually vague in nature and does not overly endorse a product.  An example might be, “The authors found that Product X was well tolerated and might be suitable for patients experiencing side effects from other medications.” 

Doctors need clinical data in order to be able to change their behavior and begin to use our product.  All clinical studies are written in an abstract that follows the SOAP template.  The SOAP process is the way doctors read and process clinical information and can be used when detailing the clinical data in your sales aids. 

  

 

  

 

 

The Importance of Clinical Data to a Doctor

Doctors are scientists and make decisions using unbiased scientific evidence.  When a doctor is trying to discover what pathology a patient is presenting with during an office visit, scientific information is collected by taking a patient history, a physical, and conducting a battery of tests such as blood chemistry, EKG, x-rays, etc.  All of this information is unbiased scientific information, they have been taught to do from medical school.  The same is true when doctors are making decisions to switch to a different drug.  

Over the last 10 years the percent of doctors reporting a desire for representatives to use clinical literature in their product discussions has risen from 80% in 2003¹ to 89% in 2012.² One survey respondent in the 2010 Sermo Survey ³ said, “If they want more time with physicians, they need to deliver more targeted clinical information to meet physician’s needs.”²  That same survey said that high quality representatives were representatives that were competent when discussing clinical studies and evidenced based medicine.  A 2008 TAP Consulting survey of eye doctors revealed that 90% of eye doctors reported a Knowledge of Clinical Studies as a trait they wanted in an industry representative.   

Due to the way doctors have been trained, and based on what they do every day they need clinical data to be able to make a decision to use your product.  If you want to ultimately change a behavior the best way to do that is to persuade the doctor by using clinical literature.  Doctors use clinical literature to challenge and change thinking.  If you want to change your doctor’s prescribing habits, you need to get familiar with your clinical data.   Now that you are convinced that doctors need clinical data, our next newsletter will focus on the best method to organize and present clinical data.  

  ¹ Accenture 2003 Physician’s Survey

² Sermo What Physicians Want Survey 2012

³ Sermo What Physicians Want Survey 2010     

 

 

 

Change your thinking from product focused to patient focused

In summary, doctors are focused on the science and concerned about how treatment impacts or alters the patient’s disease state.  Every day doctors attempt to positively impact a patient’s disease state and well being.  At the heart of your presentation are the customers and the patients they treat with your products.  As you are trying to challenge doctors thinking remember to concentrate on how your product can impact or alter the disease state, health, and well being of the patient.  Changing your thinking from product focused to patient focused will allow you to gain credibility with your doctors and help you change their behavior more quickly.

How a doctor's training impacts their decision making Part 2

During Grand Rounds, patient case studies are presented and the audience will problem solve to determine the diagnosis, and how it should be treated.  This draws on their medical school training of science and disease states, and starts the problem solving process they will carry into their residency program.  These patient cases follow the SOAP Format.  Subjective; what is the problem the patient presented with. Objective; what tests were completed and what are the findings of the initial exam.  Assessment; what is the diagnosis and Plan: what is the treatment plan.

Clinical observations are a big part of a medical students training.  At first they follow a tenured doctor around and simply watch what they do.  As their tenure grows, they take more of a role of actually conducting the exam.  As they begin to conduct the exam they will do a history and physical, gather information through tests and x-rays, make a diagnosis and decide on a treatment plan.  This entire process starts with a problem and ends with the use of a product to solve the problem.      

Doctors use science, problem solving, real-life experience and clinical date to make decisions.  Doctors think differently from sales people.  They make a decision based on what science, clinical data and their clinical experience tells them is the best decision for the patient.  I hope that you will use this knowledge to engage, challenge and change your doctors thinking this week.

How Doctors Training impacts their deciosion making

Doctors are scientists.  They make decisions based on scientific information.  They spend years studying the sciences and the disease states that our products treat.  In surveys doctors have revealed that high quality representatives are educated beyond their own product to include competitive products and the disease state their products treat.  That helps us understand that doctors want reps who know the science behind their products.  Representatives who understand the science come across as more credible than one’s who just talk about their products.

A physician in the 2012 Sermo Physician’s Survey said, “I really do appreciate the interaction between physicians and pharmaceutical reps, but have found too often that the reps I interact with have a very limited score of knowledge.”  “I find that I am much more willing to take a rep seriously if they can keep up in a discussion that is related to my field but beyond the scope of their individual product.”

Tips for Selling to Doctors

 

An Interview with Dr. Bob Nelson; Atlanta GA; How Doctors Think August 15, 2013

I think you are correct as to the influences that shape doctor’s thinking.  Koch’s postulates of scientific reasoning and causes disease are very important.  More importantly, where does all the didactic teaching leads to as far as the thought process? 

When evaluating a treatment of new drug for example... most doctors want to know the treatment or intervention interacts or influences normal physiology, as well as how it impacts or alters the disease state.  What they are told or read, must jive with the current accepted understanding of the disease process.  The result of the treatment must be measurable with a verifiable outcome.  The outcome can take many manifestations, but mostly we want to see a measurable advantage in a patient’s health and well-being the “acid test” of efficacy.  The more anecdotal verifications of data that we receive in the form of the positive patient feedback, then eventually we validate the data as “real”.  Equally important is the therapeutic index, which is essentially the ratio of a good outcome compared to unfavorable or side effects; expressed as the toxicity dose 50 / effective dose 50.  The higher the ratio the better. 

 

The other issue that I (and many doctors) look at is the absolute vs. the relative effect of an intervention.  To determine these values, it is essential to know the prevalence of a disease or condition in the population you are studying.  This is a very important concept because most pharmaceutical data is presented as “relative risk reduction/benefit increase” as opposed to absolute risk reduction or benefit.  Knowing the absolute risk/benefit numbers is essential to determining the idea of the “number needed to treat”, which is essentially the number of patients you need to apply a treatment or invention to in order to have one good outcome  (or prevent one bad outcome).  For example, the relative treatment benefit of two different treatments for unrelated conditions might be 50%.  However, if the prevalence of condition “A” is 1% and the prevalence of condition “B” is 10% then I only have to treat 20 people with suspected “B” to benefit one person.  But, I would have to treat 200 people to benefit one person if trying to intervene in condition “A”.    So, if the prevalence of the condition is very low in the population, even a treatment with a very high relative benefit or relative risk reduction could require you to treat a very large number of patients in order to benefit one person.  This must be balance, of course, against the severity of the condition you are treating: mild, moderate, life-altering, or life-threatening, etc...