Why Don’t You Eat Your Vegetables. What Can We Learn From Sales?


Everybody Sells. If physicians can’t sell their diagnosis and treatment plan to their patients, to some degree, have they’ve failed?

Patients don’t buy drugs or surgery, until they’re ready. There are steps in a buying journey, steps that apply to care.

The patient is not focused on the purchase but what the purchase enables them to do.

A good sales person understands the client’s anxieties, hopes and dreams- with the 12 minute visit, do doctors have time to understand this?


Alan Pitt: This is Alan Pitt, and I’ve started a new series here on Healthcare Pittstop entitled “Why don’t you eat your vegetables? Healthcare Issues in Communication and Behavioral Economics.” I believe new drugs and devices alone won’t change the way we care for each other, so I’m exploring some low-tech opportunities, looking at how we talk and listen to each other in hopes of getting better outcomes. As part of this effort, I’ve started exploring lessons from other industries—ones that healthcare as an industry tends to ignore. Sales tend to be a four-letter word for many physicians. In reality, though, every physician sells. If we can’t convince our patients to buy our products, our diagnoses, our treatment plans, well, that clinic isn’t really going to help very much.


AP: To that end, I’ve invited Martyn Lewis for a conversation. He was advising one of the companies that I was involved with. Martyn had something to say about what he calls “The Buying Journey,” and I couldn’t help but think that it sounded a lot like what physicians do when they’re trying to get their patients to eat their vegetables—to change their behaviors to achieve better health and wellness. So, I thought an update on the sales process might actually be interesting for healthcare providers. Martyn, welcome to the show.

Martyn Lewis: Well, thank you, Alan. It’s a pleasure to be here.


AP: I appreciate it very much. Martyn, can you tell me a bit about yourself and how you arrived at this “Buying Journey”?


ML: Yes. Do I have to eat vegetables?


AP: Well, it depends, maybe a few.


ML: Yeah. Well, I think the topic and the way you’re looking at it is really fascinating. We arrived at The Buying Journey essentially because my background is sales, marketing, executive management, and I started my own organization, my own company, Market Pundits, 22 years ago. We saw many of our clients in various industries exhibiting good sales skills, and we thought they had great offerings; offerings that would really bring value to their clients. But the clients weren’t buying—they weren’t buying the way that they expected—so the results they were getting weren’t all that they would have liked.


ML: One of the things we did is we started going behind the curtain, as it was, and talking to their buyers. Being a market research company, it was somewhat interesting and available to us to talk to our customer’s customers. We talked to them about how they’re buying, what they’re buying, why they’re buying, and why they’re not buying. And we found this huge disconnect between how organizations went to the market, how sales people were selling, how they were marketing, what they thought their customers would do, and what their customers actually were doing. And we found that the lives of buyers are really interesting and way more complex than people think. That started us on our journey, and 20 years later, we’re publishing a book just in a couple of weeks’ time, all about how customers buy and why they don’t.


AP: You actually had steps in terms of buying. There’s a process people follow. It isn’t like they just wake up one morning and say, “I want to have this thing.” Right? Can you tell me a few of these steps that you outlined about how people buy?


ML: Absolutely. Well, what we have found, that for every particular market, the buying journey is different. When you look at how people buy one thing versus another, it’s different, but inside the market, how people buy is remarkably similar. We call it the DNA of the buying journey, and how do you decode the DNA? How do you find out what people are really doing? How do you find out how they make their decisions? How do you find out why they would even be motivated to do something? How do you find out what their anxieties are? What slows them down, and what stops them? So they go through a series of steps.


ML: I’ll give you an example that comes from the healthcare industry. We did a very interesting study about how people buy elective orthopedic surgery. Here you are, you have a knee problem, maybe when you are 40 years old, because of football you played, or skiing, or whatever, you start to get a knee problem. And you probably know that this is going to end up with a replacement joint. So, the first step would be that you’re aware and you acknowledge that you have some pain in your knee. An interesting thing happens here, because what we discovered is these buyers actively do not want to buy surgery. It’s one of the few offerings that we’ve seen where the buyers actually actively don’t want to buy. They do everything they can to not have surgery. As we know, often they leave it way too long. They go through a series of steps to avoid surgery. They may do physiotherapy. They may do acupuncture. They may ignore the pain. They can drag their leg around, and actively not buy surgery.


ML: Then there’s a moment in time when they decide that, yes, it really is probably something that is going to need a joint replacement. That would take you into the next step, which is, “Okay. Now, I’ve determined I need surgery. How do I go about that?” So, that’s kind of an example of the steps, the decision-making that people go through. And each of those steps people are in a different frame of mind, they’re making their decisions differently, and they’re doing different things.


AP: As a physician, someone would come to me and my job is to offer advice, but if they’re not in the position to accept that advice, well, they may make a decision that I think is not in their best interest. In today’s 12- to 15-minute clinic visits, do you see a way that physicians might be able to move people to the next step of the buying journey, particularly if we think it’s the right thing to do?


ML: That’s such an interesting point, Alan, because we now define the role of sales and marketing in any organization as moving customers through the buying journey. So, we have to actively navigate them, support them, and manage them through that journey. And that’s a really interesting thing, because they may not have the journey clear in their own minds. They may not know the steps they’re going to go through, but they’re going to go though those steps one way or another. So, I think that, yes, it’s our role to help them along that journey and support them in that journey. A 12-minute visit? Well, that’s tough, but I absolutely think that can be done.


AP: One of the things, particularly for a sales organization, is trying to get some sort of data to measure success. Do you have anything to offer for sales organizations that could be extracted for a healthcare practice, how to move people to the next step?


ML: Absolutely. In fact, one of the most important things is to know where people are in their buying journey. We actually say that’s the very first thing, to look at where people are in their buying journey, because it’s very hard to move people forward and help them move forward if you don’t know where they are. So, the first thing is to really look at where they are. With any buying journey, we actually look factors like: How can we tell? What questions can we ask? How can we diagnose where people are in their journey? Then, with that knowledge, what can we do to move them forward? Of course, depending on where they are in their journey, it takes many different things to move them forward.


AP: It’s really a learned skill of being able to understand the buyer in the case of my clients—that is, patients—and being able to understand where they are in this process and being able to meet them where they are and be ready when they’re able to move to those next steps. Is that fair?


ML: Absolutely. And in terms of success, one of the disconnects that we saw, and I’m going to go to the classic sales world here and then we can bring it back to the world of physicians, one of the classic disconnects we saw is that the salesperson is very focused on the sale. The salesperson is focused on, “Let’s get the order.” The buyer is not focused on that, hardly at all. In fact, when buyers talk about how they go through their buying journey, they often don’t even mention the actual activity of purchasing, because they’re focused on the end result. They’re focused on what that purchase is going to enable them to do.


ML: So, if you’re buying, let’s say, a new computer, you’re not focused on actually buying the computer; you’re focused on what that computer is going to allow you to do. Maybe it’s going to allow you to play video games faster, or maybe it’s going to allow you to do extra graphics in your business, or whatever it is. If we move that to the physician area and we look at what is success and what we’re focusing on, if I go back to the surgery example, although the patient may be focused on the surgery for various reasons, what their really goal is, is joint health. They want to be running again, they want to be healthy, they want to be without pain. So, success is not bringing somebody in for surgery and having a successful procedure; success is having that person’s health restored.


AP: Yeah. That’s super interesting to me. Often, as physicians, we’re very focused on the treatment path. But I guess what you’re saying is I should almost start with a discussion about what the end result looks like to a patient. Asking the patient, “What do you hope to accomplish if we replace your knee?” Identifying what that looks like, and then the physician tries to match that to some degree. Would that be fair?


ML: I think that’s excellent. We call it an outside-in approach; you start outside. You start with the patient, you start with the customer. And you find out what their world is, and what they want from this, and what their anxieties are.


AP: Yeah. Very interesting. I’m always interested in scale. My father is a physician, I’m a physician, my daughter is a recently minted physician. Frankly, medical school hasn’t changed very much in the last 50 years—actually, longer than that, since we’ve all gone through it. Do you have any thoughts on how these types of principles could be brought into medical education or even continuing medical education for hospital systems so that they could take advantage of some of these approaches?

ML: I think you’re exactly right in the work we’ve done in the healthcare field. Of course, a lot of what we’re doing comes down to that old thing—the bedside manner. Let’s look at that moment in time, when somebody decides to have a joint replacement, and let’s take a look at that as an example. How do they decide what surgeon to go to? How do they actually decide to have surgery after they’ve been dragging their leg around and doing acupuncture and physiotherapy for years? What we’ve found happens is that they talk to somebody like them, maybe it’s a relative, a friend, or somebody they just bumped into. And that person says, “Wow. I used to have that exact same problem. Then I found Dr. Jones. Dr. Jones is simply the best. You’ve got to go see Dr. Jones. I couldn’t believe it! I was in and out in 48 hours. Three weeks later, I was walking with no pain whatsoever.”


ML: Now, here’s the interesting thing. That person, who’s been avoiding surgery for years, actually now is triggered, and they go see Dr. Jones. Now, they’ve taken the advice of somebody who has no medical expertise whatsoever, and has only had one joint replaced in their life. So, they’ve got no basis for comparison, and yet here they are saying that Dr. Jones is the best. And through that word-of-mouth referral, which is based on nothing credible whatsoever, triggered somebody to go to Dr. Jones. So, come back from that and to come to bedside manner, what is it that made that person say “Dr. Jones is fantastic” when they have no knowledge of the procedure, and they have no knowledge of the medical information around that? What triggered it, probably, is that as they were recovering from the anesthetic, a nurse walked by and said, “Oh, you’ve got one of those pillows. Let me get you a better pillow.” And gave you a pillow, fluffed it up, and all of a sudden, that patient’s experience is now special. That’s what triggered it.


AP: That’s funny.


ML: It’s incredible. It really is. In a similar way, we worked with an oncology clinic, and people went there for what reason? We discovered it was the reception. The receptionist was so organized, so competent, so good in her demeanor, how she greeted people, made sure people were comfortable, how she organized things, that people were recommending that clinic and going to that clinic time and time again, because of the receptionist! Now, that’s a really, really interesting thing when you think about it. So, to come back to your question, I think that patient care and patient handling really has to be part of what we do. It helps the patient and, of course it helps our business.


AP: Yeah. Patient satisfaction, this delivery, it’s a relatively new thing to our industry. Whereas, I think, other industries really embraced this much earlier. I did take a look at your earlier book, “Sales Wise,” and there was this long list of things that were traits of a successful salesperson, like taking the time to understand their customer, having extensive knowledge about their products. Knowing alternatives and competitive options, well, that’s basically consent. Listening to their customers. Truly understanding needs, anxieties, hopes, and dreams. Being professional, courteous, being candid and honest. All of these things could have easily been transferred to being a good doctor, yet doctors look at salespeople as kind of the taboo, almost. My bet is that that comes out of salespeople who really don’t understand the buying journey and just march to the end very quickly.


ML: You’re so right. There’s good salespeople, there’s bad salespeople. And I bet there’s good physicians, there’s bad physicians, right?


AP: Yes.


ML: The interesting thing to me, and a source of frustration, that sales has got such a bad rap. And, yes—there are bad salespeople, for sure, and there are salespeople that haven’t had the training and don’t have the expertise and don’t know their profession, which is really sad. I only wish there were professional standards and certification, like we see in the healthcare world, in the sales world. We’ve certainly helped in that way. So, yes, there are salespeople who are there and really shouldn’t be salespeople. There are salespeople that are there who just don’t have the skills, nobody’s trained them or coached them. But, yes, we’ve worked with 85,000 salespeople around the world, and the good, successful salespeople exhibit those skills.


AP: Yeah. And to use Daniel Pink’s expression, “To sell is human.” Everybody sells—whether you’re selling a product, or you’re a physician selling. You have a new book coming out. Can you tell me just a little bit about the new book, and what motivated you on that?


ML: Absolutely. Well, it’s… Somebody said, “It’s your life’s work,” and I guess it is. The name of the book is “How Customers Buy… And Why They Don’t.” And it’s essentially all of the research we’ve done. It talks about how to decode how people buy, and then essentially what to do with that. How would you approach a market based on now understanding how they buy? We find that many, many people know why somebody should buy. They know why they should eat their vegetables. And people know why they should eat their vegetables! They know why they should go to the gym—that’s not the issue. The issue is, how are they going to do that and why they may not. So, we’ve taken the emphasis away from where I think classically it’s being placed why should somebody do something, and putting on now how are they going to do it and why they may not? Because if we understand how they’re going to do it and we can support them on their journey, and we understand why they may not, we see the friction that can occur and we can stop it, and we can reduce that friction, and we can be successful.


AP: Yeah. That’s really my interest in behavioral economics. People don’t necessarily act in ways that we would anticipate.


ML: We have a common interest there. Behavioral economics is a huge passion of mine. And, in fact, yes, you’re right, the parallel is there, that people appear to not behave logically, but when you decode the buying journey, when you look at what they’re doing and why they’re doing it—Why are they resisting surgery? It’s not logical. It’s not logical to not eat your vegetables. It’s not logical to not exercise. But guess what? That’s how they behave.


AP: That’s really interesting. Martyn, I very much appreciate your time and your insights, and I’m sure anyone listening to this will maybe look at sales just a little bit differently. Thank you very much. I appreciate it.


ML: Been a pleasure, Alan. Thank you.



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