HealthAugust 15, 2019

Don't judge me: Why patients would rather confide in an automated voice than a live nurse

“Nothing compares to the intimacy and privacy of the telephone,” says Freddie Feldman, Voice Design Director, Clinical Effectiveness, Wolters Kluwer, Health.

That helps explain one of the most surprising facets of Interactive Voice Response calls (IVR): People will tell the automated calls things they wouldn’t tell a human person. It turns out that IVR calls create a safe space for disclosing information that might be regarded as stigmatizing or embarrassing.

IVR calls are automated phone calls designed to elicit important information from patients. The voice on the call is pre-recorded but the patient has the impression of talking to a person. Voice-recognition software translates the patient’s response into something the computer understands, and it moves the conversation forward to the next relevant question. (For more detail on how IVR calls can help prevent hospital readmissions, read this article on how hospitals can scale up patient outreach.)

Patients answering questions on an IVR call are often more comfortable sharing information with the technology because the computer isn’t going to judge them. These calls lower the barrier to discussing embarrassing subjects, whether it’s late-night eating habits or household financial information.

In the healthcare setting, information from the patient on questions such as depression, medication adherence, or financial capability, can be critically important in understanding whether the patient is progressing toward full health. Yet these are sometimes the subjects that patients are least willing to talk about frankly.

We developed an Emmi® program to help newly diagnosed diabetics manage their condition. We learned that most of the people participating in the program were having trouble socializing; they reported that depression had gotten in the way of their ability to manage their condition.

We further learned that the vast majority of them had never discussed these issues with a health professional. We were able to place additional phone calls that were specifically designed to give emotional support. Over the course of these interactions, overall depression scores declined. 

What makes these call campaigns so successful is that they are conceived and scripted from a place of empathy for the patient. The language of the calls is designed to normalize what the patient is experiencing, and thereby remove any stigma they perceive. As our mothers taught us, how we say something can be as important as what we are saying.

We have learned that If you rephrase the issues that need to be addressed, you can elicit more honest answers. For instance, instead of asking, “Can you afford your medication?” say: “Are you having trouble with …?” And you can add language that underscores how understandable those limitations are: “It’s a big problem for a lot of people.” This is how the call design can start to create an emotional connection, a safe space for sensitive revelations, even though the call is automated.

Another example: It’s impolite to ask somebody how much they weigh. But it’s important for clinicians to know whether patients are gaining or losing weight after a hospitalization. After a hospital discharge for heart failure, a sudden weight gain can indicate the patient’s body is holding too much fluid – an additional strain on the heart. So in our scripts we explain to patients why they should tell us if they are gaining weight.

That’s why we think thoughtful, empathetic call design, when combined with the automated voice interface, can together elicit more complete responses from patients. That in turn leads to better understanding of patients’ progress after treatment, and helps caregivers recognize when a human intervention may be necessary.

For more information on how call design encourages more forthright responses from patients, contact us.


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