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The patient journey: A long and winding road

Reflections of a research executive

To mark the 3rd anniversary of the launch of Porterhouse Insights, Research Executive, Melissa Goulding reflects on her first year working in healthcare insights and how the irregularity of human behaviour makes for a complex patient journey.

Before joining Porterhouse, my experience studying neuroscience depicted the patient journey as a cold, static diagram, painting it as a picture of consistency, efficiency and standardisation. It became easy to think that medicine, as an established and widely practised system, would be tightly held together with rigid rules, routines and protocols. In my mind, to an extent the patient journey became reduced to symptom presentation, referrals, diagnostic approaches, and, finally, treatment and prognosis. This depiction lacked depth, detail and the identity of those participating.

Although strong conventions direct the healthcare industry, studying psychology made me aware of the unavoidable nature of cognitive bias and the irregularity of human behaviour, which can be influenced by several irrational sources. This extends to clinical decision-making because, in this aspect, clinicians are no different to the rest of humankind; as such, patient management is complex, which leads to subjective decision-making and the diversification of diagnosis and treatment behaviours.

During my first year at Porterhouse, I have observed many of the quirky, intricate details that can characterise a field of medicine and subgroups of patients and healthcare professionals (HCPs). I have found that the patient journey is typically not linear and does not proceed cleanly; the reality can often be highly surprising when you take a closer look.

In our work at Porterhouse Insights, we often use real-world data (such as patient case records) and choice-based experimental paradigms, and supplement the numbers with rich qualitative data. In doing so, we have repeatedly observed how important it is to know the difference between a) what patients or HCPs claim or think they are doing, and b) what is really happening and what factors influence their subconscious behaviour. Key insights unravel explanations to existing phenomena that HCPs and patients may not be aware of .

Not only have we observed that the patient journey is complicated by pre-existing cognitive bias, human irregularity and subconscious factors of influence, but we have seen just how dynamic and constantly changing it is in the face of environmental shifts. At Porterhouse Insights, our research over the last 8 months has shown how people around the world are reacting differently to the outbreak of coronavirus, with these reactions seeping into every corner that we turn. Patients and HCPs have been affected in a variety of ways; for example, some healthcare systems are offering virtual consultations, whereas others have continued to hold face-to-face meetings. Some HCPs and patients prefer virtual communication; for HCPs this is because it facilitates quick consultations (allowing large numbers of patients to be seen per day), and for patients this is because it helps to alleviate the fear of coronavirus infection that comes with in-person interaction. In contrast, other patient groups feel highly vulnerable because the decreased amount of face-to-face time means they find it more difficult to gain reassurance and counselling from HCPs. Regulations and guidelines are changing quickly, and uncertainty regarding the near future has started to form barriers between HCPs, patients and pharmaceutical companies. It has never been more important for pharmaceutical companies to reassess the condition of their relevant therapy areas.

Everything mentioned above has contributed to why my first year at Porterhouse has been incredibly enlightening and full of unexpected findings. I am really enjoying being part of a team providing useful, actionable insights on how patients and HCPs can be supported, and I look forward to what my future at Porterhouse will bring.

Porterhouse Insights is the research, insight and evidence consultancy of the Porterhouse Medical Group. If you would like to find out more about our approach and how our strategic insights power smarter decisions and communications, please visit

3rd December 2020



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