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Irina Stefanescu (Romania)
“I do what I like and I like what I do... every day”
(Mary Poppins by Dr. P.L.Travers) CONTEXT A business manager in a pharmaceutical company invited me into her office on a November day and said:
“I am organizing a symposium on epilepsy to reinforce our product placement in the marketplace. I have arranged speakers and a festive dinner, and I thought I had done everything, but do you know what several neurologists asked me yesterday? ‘Could you bring the facilitator we worked with last year in October as we remember that workshop as a very special one. We discussed a lot, we shared from our experience, we all had time to speak, there were some serious issues we focused on, and we had fun together!’ ”
When I asked “How many participants?” her answer shocked me: “Between 100 and 120”. This would be the first time I had worked with so many specialists, many of them considerably older than me. The workshop in October one year before had been with forty participants. I took a deep breath and I started to interview her. After a long discussion about her specific goals for the workshop, we ended up focusing on three key outcomes. We wanted to create: 1. clear pictures of the patient profile in the prescribers’ minds; 2. clear statements of the product’s benefits compared to other products;
patients with epilepsy perceive the disease as a stigma and many of them experience discrimination in their families or working environments. I also had three colleagues to work with. appropriate for treatment with the product involved. likes. These had been prepared two weeks beforehand with the help of a university lecturer and researcher who had considerable experience with the product. to reinforce a favourable impression of both the company and the product. Time: half a day Warm-up 2 . dislikes and experiences. to indicate the presence of the medical condition. The sound was good and the best thing of all for me was the lighting system. a memorable event for the doctors. I had a small wooden stage. the carpet was vividly coloured and I could use the forms and colours to arrange working spaces. two cordless microphones. There was plenty of room for 110 chairs around the room in a big double circle. a laptop to project five slides. I agreed to design and run the workshop. The scientific resource I needed most was three real clinical cases. a video camera. fears. it isn’t the first choice prescription because of its high cost and powerful impact. We also considered some valuable background information: • • • the neurologists are generally not fond of diagnosing and treating epilepsy.3. a large circle of light projectors on the ceiling that could highlight a round scene on the floor. a beamer. as long as there were neither scientific presentation nor commercial claims included. This would enable the participants to be free to express their opinions. and four differently coloured sets of three ribbons. HOW I DID IT Set-up and resources The huge square conference room was ideal for this workshop. three ‘mantles’ (cloaks) made of sackcloth. although the product is highly effective. and a lighting operator. minus private details.
made the dance step two or three times. stated the goals of the workshop and named the doctors as “architects. M3. T2. four groups of drug treatment products or ‘molecules’ (M1. about the significance of this dance. so I asked everybody to show where they came from. one group to be the Ministry of Health (MH). on the stage and then invited everybody to do it.For the warm-up. The simplest Flamenco step. as they don’t like epilepsy too much? I needed to empower them to believe in their therapeutic holistic role – they are treating not only a disease. I remembered Jörg Burmeister’s story about Flamenco. used by both women and men. Why should they move. M4 represented three competitors’ products). I needed a good. so I invited the group to form a spectrogram.) (T1. but also a human being with mind. I used the months of the year. soul. M3. spirit and body. I introduced myself briefly. Once they were standing and dancing. I told a story about Flamenco and its birth in Andalusia. I needed to know quickly which participants were the most experienced in working with this product. M2. The twelve groups were: • • • three groups of ‘patients’ (P1. I learnt who were the specialists I could count on for any technical questions. The last thing before warming up for roles was to establish twelve groups of equal size. quite loudly. stepping and smiling! Participants needed to feel secure and to begin to explore the space we were working in. onto the wall. then started smiling and became curious about the sounds of other places. means “I have the right to be. I asked the resulting groups to demonstrate the specific sound of their place. impactive story to reach their minds and hearts. neurologists etc. with Flamenco music in the background. M4 – M1 represented the company’s product. inviting the participants to arrange themselves according to the month of their birth. and T3 – T1 is therapist for P1. and also to redefine their role as therapists. M2. T2 for P2 and T3 for P3). P2 and P3). they became involved! In just seven minutes they were up on their feet. They talked for one minute. here I am!” So the title of the workshop was Restore self-confidence with just one step. I beamed a huge picture of Flamenco dancers dressed in red. three groups of ‘therapists’ (doctors. who restore the inner beauty of your epileptic patients by helping them to regain their self-confidence” . • 3 . After interviewing five of them.
4. M2. M2. to go to each patient and tell why that particular ‘molecule’ (treatment product) would fit or fail to fit the patient’s needs. P2. handed to M1. M2. M4. We then repeated the process with pairs P2-T2 and P3T3. T1 asked questions and received answers. We handed a set of three ribbons to each ‘molecule’ (or drug product) group. All three clinical cases were also. There were no diagnoses. • • • T1. M3. one at a time. P3 – the stories of the three patients. just age. P1 told their story to T1. that of the second patient to P2 and T2 and the third one to P3 and T3. 1. I showed three slides detailing the three clinical cases and then gave the clinical report of patient 1 to P1 and T1. to find two things they had in common apart from being doctors. no names. T3 – the questions to be used to probe the patients. T2. M4 – the possible benefits for each patient of that particular treatment product. T1. to select a main actor for the group. M3. 3. 3. simultaneously. onto the stage to tell his / her story. gender. we dressed that person with the ‘disease mantle’ and invited the person to sit on a chair. Each group had 18-20 minutes to carry out the following tasks: 1. to prepare: • P1. M1. Enactment As the patient groups sent their representatives. T2 and T3 were invited to return to their groups and discuss the possible diagnosis. MH and NHIH – what is most important when dealing with these patients from these organisations’ perspectives and what are their main goals. the town they came from and three personal traits. neurologists or something other highly obvious category. Meanwhile M1. no jobs. one after the other. 2. symptoms and some previous episodes described very briefly. M3 and M4 were invited.• one group to be the National Health Insurance House (NHIH). MH and NHIH. to introduce themselves to each other saying their name. 4 . 2. and no information about family.
T1. If a ‘molecule’ considered herself appropriate for a patient. T2 and T3 groups were then invited to confer for three minutes about the treatment they would have recommended as ‘therapists’. They retained vivid images of the patients on the stage and they remember which drug treatments 5 .outlining indications. I got everyone to dance the Flamenco step again. then she would place a ribbon around the neck of the patient. and T3 then informed their patient (T1 to P1. and advised the patient about the appropriate life-style for the treatment to be effective. main benefits. drug interactions and the mechanism of action. T2. treatment terms. They then reflected and made a record of the learning points they were taking back home. people had twelve minutes to briefly share from roles and from their personal experiences linked to what had happened on the stage. Then. Nobody normally tells the specialists how to manage relationships with patients. thanked the group and said goodbye. Sharing The ‘patients’ took off their ‘disease mantles’ while still on the lit stage. This was a very important part of the workshop. End Finally back on the small wooden stage. T1. I explained my conclusions from my observations and congratulated them on their role of ‘self-confidence restorers’. etc. side effects. 4. with the Flamenco music in the background. back in groups. 5. these were presented to the entire audience through another group member. and shared loudly from role about how they felt they had been treated and what had happened to them during the enactment. then they took the ribbon off the patient while justifying the decision. in their feedback to the medical representatives. 6. because it was a powerful educational moment about managing the relationship with the patient. If they didn’t validate a ‘molecule’. still remember the workshop.) of their diagnosis and the recommended treatment. MH and NHIH assessed the treatment according to their particular goals and policies. Conclusion What happened to the three goals we had? Fourteen months have passed since then and the doctors.
(‘molecules’) were chosen and why. The medical representatives can still rely on those images to build new patient profiles and to remind them of the product’s benefits. 6 .
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