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Developing a new holistic approach to managing diabetes type II.

One of world’s largest pharmaceutical companies approached McKinsey to investigate why diabetes Type II patients were not sticking to their recommended treatment protocols. With no prior knowledge of diabetes, I found myself in charge of this research project, having to present my findings to the company’s global senior management team in a month. One month and a few hundred kilometers on a scooter around Paris later (France was chosen as the test market), my team presented the findings that ended up changing the company’s entire approach to treating diabetes, laid the foundation for its digital strategy, and changed the way in which the company conducted its research.

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In order to start having at least a remote idea of discussions around the table, before the first client meeting, I spent a weekend reading everything I could (and watching lots of YouTube videos) about diabetes. Moreover, I spoke to a friend who is a medical student, to get her explaination of how diabetes actually affected the body, and what drugs were on the market, and how they worked. I learned about different diabetes types, key KPIs such as blood sugar levels, and the mandated French treatment approaches at various stages of the disease. This homework was sufficient not to say anything stupid on that first client meeting, yet I still felt like the dumbest person in the room. Over the years I’ve learned that the “Beginners Mind” is a big asset of a UX designer. However, one should never come across unprepared.

The working group had a hypothesis that the reason why diabetes was not managed properly was because doctors had no time to explain the treatment approach during a 15-minute meeting that the state insurance would reimburse them for. So initially the design problem was formulated as “how can we improve the efficiency of the 15-minute GP consultation meeting?”

To test this hypothesis, the team first dug itself into the next round of desk research. We consulted hundreds of reports and research papers, also looking at other similiar diseases (e.g. Hypertension). Next, we decided to conduct in-depth interviews with GPs and patients that we recruited using a medical research recruiting agency. Speaking little French, I had to rely on my good friend and a colleague from the Paris office, Louis. The problem was that Louis had no prior experience with in-depth interviewing techniques - and yet, we had no other choice than to teach him those skills. I introduced him to a few classic mistakes, such as overexplaining; and a few core skills, such as probing, pregnant silence, and others; and we later role-played various situations to practice. Over the next 2 weeks we had to conduct over 30 interviews with GPs and patients in various parts of Paris, causing us to drive around like madmen in hectic Parisian traffic, trying to make our appointments.

First, the patients. The most surprising thing we’ve observed in our patient interviews was how eager they were to talk to us about their condition. For long periods of time they confessed to us how lonely the experience has been for them. From the initial diagnosis that often left them feeling confused and scared, to having to embarrisingly explain their condition to family members (who often didn’t take it seriously) to struggling to readjust their daily lives around the disease. One woman recalled an episode how her husband got angry at her for starting to cook salads for dinner and not fatty meaty dishes that he was used to. Overwhelmed, some patients disconnected entirely and fatalistically hid their head in the sand, starting to skip doctor consultations and making no changes to their lifestyle.

But we also met different types of patients - the ones who couldnt thank their doctors enough, saying that their doctors were like “coaches”, rooting for them from the sidelines. These doctors found ways to clearly explain to them and their family members what diabetes was and how to manage it. They gave pep-talks when the test parameters were low and went “above-and-beyond” for their patients.

Now, the doctors. The most striking thing for me was how different these doctors were! I thought that all doctors were more-or-less the same and it didn’t matter that much to which one you went. They all went to the same medical schools after all. Yet we started noticing remarkable differences between them already in their waiting rooms! Some were fancy, with glossy magazines and designer furniture; others looked like part-hallway-part-kitchen-part-storage-space. Some doctors listened to us carefully and empathetically, while others wouldn’t even let us finish our questions, offering their “the one and only” answer with badly hidden contempt. Some doctors had the latest Macbooks and let their patients ask them questions by WhatsApp, while others had no computers at all and had a strict “by appointment only” policy.

The most interesting differences started to appear when we asked the doctors to describe what happens after the patient is diagnosed with diabetes (unfortunately we couldn’t witness an actual patient consultation due to patient confidentiality rules). Some said matter-of-factly “I tell them to eat better, excercise more, give this prescription, and send them home. I don’t waste my time, because most of them are not going to change anything anyway”. Other doctors with entousiasm shared with us YouTube videos they watch together with patients to explain them how diabetes works. They told us about stories how they asked patients to bring their spouces to help them manage diabetes together. They told us stories how they would go to patients’ homes to see what food they were eating and showed us various “games” they invented to help the patients.

What explained such a difference? Why after almost 10 years of studying, some doctors seemed so demotivated while others seemed to be shining with entousiasm. What we found, shocked us. Paper after paper showed that one very possible explaination was depression. On average, 40-60% of doctors in the US and EU suffer from depression. Could it explain the lack of motivation for treating patients we’ve observed in so many doctors we visited?

Note: Diabetes Type II is a lifestyle disease that can come from lack of excercise, obesity, eating too much fatty and sugary food, smoking and other bad habits; to successfully manage it (you can never really “cure” it) a patient has to change her entire lifestyle - pills alone are only responsible for about 30%.

To test this hunch, the team sent out a quantitative survey to thousands of doctors and found a very clear relation between consultation time and work motivation. We were on to something.

Eventually, we figured out an entirely new model. Structured as a logic tree, it showed that to get treated properly:

The patient first has to see a doctor who is not depressed. Depressed doctors wouldn’t explain the disease well enough, leading to the patient either not taking it seriously, or taking it so seriously that they end up feeling completely overwhelmed.
The next step was convincing your family and friends to support you. Without the support of family and friends, patients didn’t have the necessary “infrastructure” to implement the difficult lifestyle changes.
Then there were numerous other branches that I can’t disclose due to confidentiality purposes...

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