THE MSL

Journal of the MSL Society

The Cynic in the Clinic: Overcoming HCP Distrust Using Behavioral Science


Author(s):

Information presented to a health care professional (HCP) is only as valuable as their willingness to accept it. An HCP’s distrust in a medical science liaison (MSL) may inhibit the MSL’s ability to effectively transfer scientific knowledge. In The MSL Journal’s Spring 2024 issue, Dr. Amy Patel analogized the levels of KOL relationship development to the three phases of dating, engagement, and marriage.1 In doing so, she identified trust as a key outcome of each stage. Through the lens of behavioral science, this article will discuss how trust is formed, what MSLs can do to establish trust with HCPs early in a relationship, and how MSLs can strengthen that trust over time.

STATE OF TRUST IN HEALTH CARE

Global trust in health care companies, health media reporting, science, innovation, and institutions in general continues to decline.2-3 Public distrust in pharmaceutical companies can largely be attributed to commercial motives.4 Although HCPs have more experience with the pharmaceutical industry than the general public, it is plausible that public discourse amplifies their skepticism toward pharmaceutical/MedTech companies and their personnel. Thus, it may be more important than ever to adjust HCP engagement strategies to strengthen trust perceptions.
Research tells us that HCPs generally have favorable attitudes toward sales representatives but question the information they receive because of commercial interests.5-6 However, little is known about their perceptions of MSLs. MSLs are tasked with communicating objective, scientific information; a practice that is safeguarded by systems that protect their role from commercial influence. Despite their non-promotional nature, MSLs may encounter the same HCP skepticism as sales representatives. The MSL’s ability to quickly establish trust and strengthen it over time is key to engaging in high-quality conversations with HCPs and allowing them to confidently apply new information in practice.

WHAT IS TRUST(WORTHINESS)?

Trust, defined as the willingness to accept the risk of being vulnerable to the actions of others, is made up of four components including propensity to trust, perceived trustworthiness, affect, and heuristics.7 Trustworthiness is based on perceptions of a trustee’s ability, benevolence, and integrity.7 These trustworthiness perceptions interact with the trustor’s propensity to trust, affect, and heuristics to form a trusting (or distrusting) attitude.8 Trust is then achieved when the trustee is willing to accept the risk of being vulnerable.7 In the relationship between HCPs and MSLs, an HCP’s willingness to adopt an MSL’s information is a good indicator of trust.

TRUST DEVELOPMENT

HCPs lack the necessary information to judge an MSL’s trustworthiness early in a relationship. To compensate for this information deficit, HCPs rely more heavily on heuristics. During this period of unfamiliarity, MSLs can signal ability and integrity, but benevolence must be experienced over time.9 An MSL trying to signal benevolence or express that they would put an HCP’s interests before their own may appear awkward and even generate suspicion about the MSL’s intentions. Rather, the HCP will learn that the MSL cares about their goals through repeated positive interactions.

Figure 1: Concepts Associated with Trustworthiness Dimensions

Guided by the concepts associated with the ability, benevolence, and integrity dimensions shown in Figure 1, MSLs can take actionable steps to communicate trustworthiness:

SIGNAL ABILITY AND INTEGRITY

  • SELF-PROMOTE: Perceived expertise substantially contributes to being seen as a credible source of information. If possible, expertise should be established before communicating new information. HCPs may rely on the reputation of an MSL to develop judgments of credibility, so MSLs should ensure their online professional profiles are up-to-date, easily accessible, and effectively communicate their expertise. Additionally, maintaining an active online and in-person presence in relevant professional networks can enhance perceptions of expertise.
  • GET AN ENDORSEMENT: Being introduced by a colleague who the HCP considers credible may transfer that perception of credibility to the MSL. The introduction also allows the third party to outline the MSL’s expertise, avoiding the risk of an MSL appearing to be self-aggrandizing by trying to establish credibility on their own.
  • INDICATE INFLUENCE: An MSL can increase an HCP’s confidence in them by indicating that they have the position, influence, and/or resources to deliver on their promises.
  • KEEP IT BRIEF: MSLs should tailor presentations to the needs of the HCP as MSLs may lose credibility if they include too many irrelevant details.10
  • BE RELIABLE AND CONSISTENT: MSLs should deliver on promises, even ones that seem inconsequential. Consistency creates predictability, which leads to increased perceptions of credibility. Where practical, MSLs should have a way of doing things and stick to it (e.g. always sending confirmation emails the day before meetings).
  • REMAIN OPEN AND TRANSPARENT: To be truly objective, an MSL should disclose any vulnerabilities in the information they communicate. Additionally, MSLs should consider using language that allows them to take a more neutral advisory position rather than one that may be construed as promotional (e.g. “The best we know right now…,” “The data show…,” etc.). And MSLs should not hesitate to say, “I don’t know, but I will try to get you the answer.”

BUILD ON BENEVOLENCE OVER TIME

  • PUT PATIENTS FIRST: MSLs can establish a feeling of partnership with the HCP by focusing on patient outcomes. Doing so serves as a cue that reminds HCPs that, like them, the MSL is an advanced medical professional dedicated to helping people live long, healthy lives.
  • BE THOUGHTFUL: Each HCP has a unique set of goals, curiosities, concerns, etc. Take time to learn about those, document them, and prioritize connecting the HCP with resources that help them fulfill their needs.
  • ENGAGE IN ACTIVE LISTENING: Active listening shows that the MSL prioritizes the needs of the HCP and their patients.
  • BE RESPONSIVE: Striving for same-day responses rather than defaulting to a 24- to 48-hour response time demonstrates that the MSL cares about the needs of the HCP. Plus, the best time to respond to an inquiry is when the subject is still top-of-mind for the HCP.

FINAL THOUGHTS

Some of these techniques require finesse, a mastery of soft skills, and a delivery that rises to the level of fine art. While many of them seem obvious, tending to the complexities of relationship building is often sacrificed for other priorities. MSLs who intentionally incorporate these techniques into their engagements can expedite trust formation, strengthen MSL-HCP relationships, and remove barriers to successful knowledge transfer.

References

  1. Patel, A. KOL relationship building. The MSL: Journal of the Medical Science Liaison Society. March 6, 2024. Accessed May 21, 2024. https://themsljournal.com/article/kol-relationship-building/
  2. 2024 Edelman Trust Barometer. Edelman. 2024. Accessed May 20, 2024. https://www.edelman.com/trust/2024/trust-barometer
  3. 2024 Edelman Trust Barometer special report: Trust and health. Edelman. 2024. Accessed May 20, 2024. https://www.edelman.com/trust/2024/trust-barometer/special-report-health
  4. Ahmad M, Akande A, Majid U. Health care provider trust in vaccination: A systematic review and qualitative meta-synthesis. European Journal of Public Health. 2022 Apr 1;32(2):207-13.
  5. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: A systematic review. BMJ Open. 2017 Sep;7(9):e016408.
  6. Kesselheim AS, Robertson CT, Myers JA, Rose SL, Gillet V, Ross KM, Glynn RJ, Joffe S, Avorn J. A randomized study of how physicians interpret research funding disclosures. New England Journal of Medicine. 2012 Sep 20;367(12):1119-27.
  7. Mayer RC, Davis JH, Schoorman FD. An integrative model of organizational trust. Academy of Management Review. 1995 Jul 1;20(3):709-34.
  8. Baer MD, Colquitt JA. Why do people trust?: Moving toward a more comprehensive consideration of the antecedents of trust. In: Searle R, Nienaber AM, Sitkin S, eds. The Routledge Companion to Trust. Routledge; 2018:163-82.
  9. Blomqvist K, Cook KS. Swift trust: State-of-the-art and future research directions. In: Searle R, Nienaber AM, Sitkin S, eds. The Routledge Companion to Trust. Routledge; 2018:29-42.
  10. Reinhard MA, Sporer SL. Content versus source cue information as a basis for credibility judgments. Social Psychology. 2010 May 10;41(2):93-104.

About the author:

Justin O’Rourke, MA, MBA

Justin O’Rourke is a behavioral science subject matter expert specializing in relationships between pharmaceutical companies, prescribers, consumers, and other health care system stakeholder groups. In addition to an MBA from the University of Wisconsin–Whitewater, Justin holds a master’s degree in industrial-organizational psychology from The Chicago School where he is a student in the Business Psychology PhD program. Justin’s doctoral research focuses on trust dynamics in the HCP-MSL relationship. His other areas of research interest include peer-to-peer influence, physician decision-making, and medical affairs engagement strategy.

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