Built-in Skepticism

Of all the stakeholder types in the Belief Gap universe, including investors, patients, and KOLs, physicians may be the most structurally resistant to belief. A physician who quickly adopts new medical technology without waiting for more data or questioning the evidence takes a big risk, while a physician who takes a “wait and see” approach is considered prudent. The belief threshold for physicians is not just higher, it is architecturally different because skepticism is built into their professional culture, training, and even their personalities.

To learn more about why physicians are skeptical and how medtech developers can overcome this challenge, we spoke with Dr. Errol Norwitz, Executive Director of the Kerry Murphy Healey Center for Health Innovation and Entrepreneurship at Babson College, Past President & CEO of Newton-Wellesley Hospital, and Professor and past Chief Scientific Officer and Chair of OB/GYN at Tufts Medical Center/Tufts University School of Medicine. 

What's Behind the Skepticism

To Dr. Norwitz, belief is a dangerous concept. He says, “It's why we as humans evolved to have such a powerful brain. We are all individuals, and we each get to weigh the evidence and make decisions for ourselves. One shouldn’t simply believe what other people tell you.” Given their role, it’s particularly vital that clinicians don’t simply accept what they’re told at face value.

It’s also part of who they are. Dr. Norwitz says, “In my opinion, medicine selects people who are inherently conservative and skeptical, cautious and reluctant to change. We have a dictum in medicine: primum non nocere, ‘first do no harm.’ It is one of the pillars of medical practice—make sure what you're doing is safe. It doesn't matter what the CEO, or the Department Chair, or the Division Director says; doctors are there to protect their patients. Top of mind for them is: ‘If I accept these data and take this action, what will happen to my patient?’”

This combined with what he calls “a certain amount of hubris” makes the job of medtech developers even more difficult. Physicians will listen to other physicians, but when you as a non-physician try to get in front of doctors to persuade them, you’re at an immediate disadvantage. Dr. Norwitz says, “It's not that you can't overcome that challenge, but you have to recognize that it's inherently built into the system, even if it's not right. Not only are clinicians skeptical because your goal is to try and sell them something, but all too often they don't see you as having the same status, which is unfair because your knowledge in that specific domain may well be greater than theirs.”

Dr. Norwitz adds, “Physicians are not comfortable with uncertainty; in fact, they are terrified of it. Their patients come to them with questions, with symptoms, and they want answers. When doctors can't give a clear answer to their patients, they get stressed, they get uncomfortable. One of the courses I teach for first-year medical students at Tufts is around the issue of uncertainty—what it is, how you deal with it, and how to better understanding your personal ‘uncertainty tolerance.’”

How to Build Confidence and Trust

Dr. Norwitz sets forth four key tactics to help you build trust with the physician stakeholders you need to help you launch your medical device into the world. He advises, “First, think carefully about who presents the message. If you can get someone that doctors will respect to review the data and support your argument, that will help. Make sure you have highly credible people on your board of advisors. If they are passionate about the product, they can reach out and encourage clinicians to sit down and speak with you.” He explains, “If someone who is highly regarded in the field reaches out and says, ‘Take a look at this, I think it’s really interesting,’ the party you are interested in meeting with is far more likely to hear you out, and they'll be primed for your presentation a little bit differently.” Find the right messenger for your product in order to navigate clinicians’ assumptions about innovators.

The second tactic involves your data, which must be sound. Dr. Norwitz says, “Doctors and scientists will immediately focus on the data. And if they don't trust the data, you've lost them. Don't try and massage the figures. Their job is to pick the data apart and find fault with it.” And he advises, “Be honest about the data you don’t have. As soon as you’re dishonest about something or there is even a perception that you are trying to hide something, you've lost credibility. If you have a problem with the data, then acknowledge it. Physicians know how hard and how time consuming and expensive clinical trials are to conduct. If you are honest, even if there is a weakness in the data or a question you haven’t yet been able to answer, be transparent about it. You'll build that trust level as you go.”

The third tactic is to tell a compelling story. Dr. Norwitz says, “It’s one thing to show data, but coming up with a compelling personal story to share can be equally impactful. I always try to lead with a personal story; it allows you to put the problem in context. Even though we are reluctant to admit it, people generally make decisions based on emotion rather than logic.” As explored in our other articles, we know that belief is driven by emotion; therefore, develop messaging that evokes positive emotions around patient outcomes. Given that clinicians’ number one concern is the patient, Dr. Norwitz says, “Physicians need to know: what is the current standard of care and how does your product compare to it? What are the benefits? What are the disadvantages? If it's safer than the existing therapy, clinicians may buy into it. If it's more effective, they may buy into it. If it's both, they're on board.”

A fourth tactic is the concept of co-development. Dr. Norwitz says, “Let's say you've got an innovative orthopedic device. Find a provider who can become a strategic partner and work with them to co-develop it. If it’s early stage, they might want a share of the IP. But if you've already done the foundational research and secured the IP, you might say, ‘You can get a paper out of this. And, if the data are compelling and you are convinced this device is going to add value, we would like to have you present it at a national or international meeting.’ Get them on board; get them to buy in.” This partnership locks in their support and adds credibility as you reach out to other clinicians for broader adoption.

Providers First, then Hospitals

If a physician believes in your device, that’s great. But even with a doctor’s buy-in, you need the hospital or health system to be on board too, and that’s where cost comes into play. If the CFO doesn’t see an opportunity for cost savings, the hospital will not purchase your product. You must have both physicians and hospital leadership on your side.

Dr. Norwitz advises, “First get the providers on board. Then you can persuade the CFO to bring your product into the hospital or the healthcare system.” He points out, “Finance people care about price first, but they also care about cost-saving measures such as more efficient workflows. Let's say the hospital is having a supply chain challenge and you can solve it for them. That's great. Maybe they have a value-based care contract that measures metrics like hospital readmission rates or ensuring that diabetic patients get an eye exam every year and reimbursement are tied to those metrics, then demonstrate that your device or platform can help them meet those metrics. Or maybe you have an approach that will create efficiencies in those areas of the hospital that represent the most valuable real estate like the ED, the ICUs, and the ORs. That will help you to convince the CFO.” As with physicians, you need to understand where finance people are coming from and what they care about. Then you can develop data that address their pain points and get them on board.

Benefits of Persuading the Skeptics

The Belief Gap framework characterizes physicians as the most structurally resistant stakeholder type in med tech. According to Dr. Norwitz, it’s embedded in who they are. Everything from their clinical training, the professional culture in which they work, and the personality types that drew them to the practice of medicine in the first place reinforce the message that skepticism is a virtue—not a flaw. They will ask hard questions, shake their heads, and doubt your claims. But persuading these skeptics can lead to enormous benefits.

Dr. Norwitz says, “If you can convince providers that what you have to offer is superior to what they are currently doing and is going to improve patient care, they will commit. They will then spread the word to their colleagues and friends. Then, if a competitor comes along and wants to change their mind, you've created a much higher barrier to entry.” He adds, “So there is a real advantage to taking the time and making the effort to get these skeptics on board. If you are able to convince them, now you've locked in some dedicated long-term customers.”

When you look at belief as an irreducible mix of emotion and intellect, and you understand that physicians are cautious and dread uncertainty, you can calibrate your communication for their belief threshold. You’ll then be able to persuade these most skeptical of stakeholders that your device is a solution they can believe in.

About Dr. Errol Norwitz

After 15 years in leadership roles at industry leaders including Stryker, Philips, and Johnson & Johnson, Ilana Lam Gotlib founded ILG Consulting, LLC with a focused mission: helping healthcare innovators tell their stories. She brings a deep conviction that even the most brilliant technologies can get lost without a clear narrative — and built her firm to be the strategic partner she always valued, one who can cut through complexity, find the "hook," and prepare teams for their biggest moments. Whether refining an investor pitch, structuring a strategic partnership, or navigating a growth hurdle, she works as an extension of her clients' teams, combining the rigor of a corporate background with the agility and personal attention that startups deserve — ensuring they are Pitch Ready, Growth Ready, and Partner Ready.