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Over the past few months, I've found myself having more regular dinners with friends from the pharmaceutical insights and analytics world. One of the unexpected pleasures of this stage of my career is that many of these relationships have evolved far beyond clients, colleagues, and conference acquaintances into genuine friendships. And I've come to appreciate something about our industry: (not to sound self-congratulatory or anything but...) people who spend their lives trying to understand human behavior tend to be remarkably curious, thoughtful, and oftentimes hilarious dinner companions.
One set of friends in particular has become a frequent source of those conversations that begin casually over appetizers and somehow end 2-3 hours later with all of us questioning things we've taken for granted for years. These two have spent most of their careers in I&A, and as often happens when researchers get together, our conversation eventually drifts toward methodology. More specifically, we found ourselves talking about emotional drivers research, a category of work that has become increasingly prominent across healthcare over the past decade.
On the surface, the industry's growing interest in emotions, both HCP and patient/caregiver, makes perfect sense. As pharmaceutical companies have become more patient-centric, they have invested heavily in understanding the patient journey: not just what patients do, but what they feel.
These are important questions.
Yet as we continued talking, a question emerged that has stayed with me ever since: when patients tell us how they feel, are we hearing authentic emotions, or are we hearing their interpretation of those emotions?
As our conversation unfolded, I found myself starting to wonder whether we might occasionally be placing too much confidence in the answers we get in our studies. Not because patients are being dishonest. But rather because emotions are surprisingly difficult things to accurately access, describe, and measure.
As I have found myself spending more and more time interviewing patients over the past few years, as opposed to just healthcare professionals, I've started noticing something. When patients talk about their experience with a serious or chronic illness, they often don't begin by describing emotions. Instead, they talk about life.
They talk about scheduling appointments. Managing medications. Dealing with insurance companies. Getting authorized for diagnostic procedures. Coordinating care across multiple specialists. Missing work. Taking care of children or aging parents. Dealing with fatigue. Trying to maintain some semblance of normalcy while navigating a healthcare system that often feels anything but normal.
What strikes me about many of these conversations is that patients frequently seem less focused on their emotional state than on regaining a sense of control over their lives. That observation has led me to wonder whether, as marketing researchers (and marketers alike), we sometimes impose an emotional framework onto experiences that patients themselves actually experience more pragmatically.
When we ask someone, "How did you feel when you received your diagnosis?" they will almost always give us an answer. In fact, many respondents are remarkably articulate and convincing - and it can sometimes be as powerful as a Shakespearean stage performance! I've seen videos of compelling patient testimonials circulate throughout a pharma company. BUT...I find myself wondering whether that answer is always a direct expression of an authentic emotional experience, or whether it is, at least in part, a retrospective reconstruction of what they believe they should have felt at the time.
I'll tell you this: I honestly don't know.
And that uncertainty has made me increasingly thoughtful about how I interpret emotional data in a marketing research setting.
To be clear, I'm not suggesting that emotional drivers research lacks value. Quite the opposite. Some of the most important insights I've ever encountered have emerged from conversations about fear, hope, anxiety, relief, uncertainty, and resilience. Nor am I trying to kick the stool out from underneath an entire category of research that has helped our industry transform and become more patient-centered and empathetic.
Rather, I think this is a reminder that emotions deserve the same level of scrutiny and interpretation (and skepticism) that we bring to any other form of data.
As researchers, we are not simply collecting emotions. We are collecting people's descriptions of emotions, often after the fact, in an artificial interview environment, and asking them to make sense of experiences that may have occurred months or years earlier. That does not make the data any less valuable. But it does mean we should approach it with a degree of humility.
The challenge, then, is not whether patients experience emotions. Of course they do! The challenge is determining whether what we are hearing is the emotion itself, the memory of the emotion, or the story that has been constructed around it over time.
And those are not necessarily the same thing.
Part of the challenge, I think, is that healthcare marketing researchers can sometimes assume that illness is, by definition, an emotional experience. And of course, sometimes it is. A cancer diagnosis can be profoundly destabilizing. A rare disease diagnosis in a child can alter the course of an entire family’s life. End-of-life decisions can carry layers of fear, grief, guilt, hope, and uncertainty that are difficult to put into words.
But not every healthcare experience lives at that emotional level.
For many patients, the more dominant experience of illness is not emotional intensity so much as practical disruption. The disease gets in the way of ordinary life. It complicates schedules, interrupts habits and routines, creates administrative burden, and forces people to spend more time than they would like thinking about something they would rather not think about at all. What they want, more often than not, is to feel better, regain control, get back to their lives, and stop having the illness define their day-to-day.
That is why I sometimes wonder whether what we code as an emotional driver is, in some cases, something closer to a desire for normalcy, predictability, or control. Those ideas are related, certainly, but they are not identical. And I think that distinction matters.
There is another aspect of this that I find my mind wrestling with, and it has less to do with emotions themselves than with the circumstances, the setting, under which we ask people to talk about them.
When you really stop and think about it, the marketing research interview is a somewhat peculiar social interaction. We recruit a respondent we have never met before, strive to establish rapport as quickly as possible, and then proceed to ask them questions about deeply personal experiences, motivations, decisions, fears, frustrations, hopes, and feelings. Often, we are asking them to revisit moments that occurred months ago or even years ago. We ask them not only to remember what happened, but also to explain what it meant and how it felt.
That is a remarkable thing to ask another human being to do.
The grayer I get as a researcher, the more I appreciate how much cognitive work is actually taking place in those moments. Respondents are not simply retrieving a file from a mental cabinet labeled "emotions" and handing it to us. More often, they are mentally reconstructing an experience. They are taking fragments of memory, pieces of feeling, things they have since learned, conversations they have had with family members, and stories they have told themselves over time, and weaving those elements together into a coherent narrative that makes sense in the present. There might even be embellishments and mythology woven in.
That narrative is incredibly valuable. In many ways, it is precisely what makes qualitative research so rich. But I have become increasingly cautious about assuming that the narrative and the original emotional experience are identical.
If someone asks me how I felt about a particular event that occurred three years ago, I can certainly give an answer. The question is whether I am describing what I actually felt in that moment, or whether I am describing my current understanding of what that experience meant. Those are related things, but they are not necessarily the same thing.
This is one reason I have become more interested in approaches such as diary studies and other methods that allow us to get closer to experiences as they are unfolding. The shorter the distance between the experience and the description of the experience, the less opportunity there is for memory, interpretation, and storytelling to reshape what happened. That does not eliminate bias, of course. Nothing can do that. But it may bring us a little closer to the thing we are actually trying to evaluate.
Again, let me underscore: none of this diminishes the value of emotional drivers research. If anything, it makes me appreciate how difficult and nuanced that work really is. My concern is simply that we sometimes move too quickly from what a respondent says to what we conclude. The interview itself is an artificial environment, and the answers we receive are often filtered through memory, self-perception, and hindsight. As researchers, we need to bring the same degree of judgment and interpretation to emotional data that we bring to any other form of evidence.
Perhaps this is one reason I have found myself increasingly drawn to research approaches that capture experiences closer to the moment they are actually occurring, and in ways that are more universal and rely less upon the written word.
Over the past few years, I've become intrigued by digital ethnography for this very reason. What makes digital ethnography particularly powerful is that it allows people to express themselves in ways that go beyond verbal language alone. Participants can record videos. They can upload photographs. They can leave voice notes while sitting in a waiting room, driving home from an appointment, or navigating a difficult day with their condition. They can document aspects of their lives that might never emerge during a traditional interview simply because the interview itself does not always foster the right conditions for those observations to surface.
In many ways, these approaches acknowledge something important: human beings do not naturally experience their lives in the form of discussion guide questions. We experience them through moments, interactions, routines, frustrations, interruptions, relationships, and environments. Sometimes a photograph of a kitchen counter covered with medication bottles tells us more than ten minutes of discussion about treatment burden. Sometimes a brief video recorded after a difficult appointment or a treatment infusion conveys something that a respondent would never think to mention when speaking to a moderator weeks later.
Even tools such as emotion wheels, which I continue to find useful, are valuable not because they magically reveal hidden emotions, but because they help respondents recognize and articulate nuances they might otherwise struggle to express. They provide a language for experiences that are often difficult to put into words.
Ultimately, I don't think the goal is to eliminate interpretation. That would be impossible. The goal is simply to move a little closer to the lived experience itself. The closer we can get to the moment when something is being felt, experienced, or navigated, the more confidence I have that we are studying something authentic rather than merely the memory of it.
As I've been thinking about this topic and talking about it with dear pharma I&A friends, I've become increasingly convinced that the answer is not to abandon or undermine emotional drivers research. If anything, I think emotions matter enormously in healthcare. Anyone who has spent time thoroughly and intently conversing with patients facing cancer, rare diseases, chronic illnesses, or life-altering diagnoses understands that emotions are woven throughout those experiences in ways that are often profound and deeply personal.
What I am suggesting is something a bit more modest.
As researchers, we should probably be careful about assuming that every emotion articulated in an interview represents a direct window into an underlying emotional driver. Sometimes it does. Sometimes a respondent is describing a feeling they experienced vividly and can recall with remarkable clarity. But other times they may be describing a practical challenge that has been translated into emotional language. Or they may be explaining what they believe they should have felt. Or perhaps they are doing what all of us do when reflecting on our lives: constructing a narrative that helps make sense of an experience that was confusing, frightening, disruptive, or difficult to process when it actually occurred.
The more patient research I conduct, the more I appreciate how difficult it is to unpack and separate those things.
In many ways, this takes me back to the conversation that sparked this essay in the first place. We have developed a much greater appetite for, and have become much more sophisticated as an industry to understand the patient experience, and I think that is unquestionably a good thing. We are asking better questions. We are listening more carefully. We are trying harder to understand what life actually feels like for the people we ultimately serve.
But perhaps part of that responsibility is recognizing that emotions themselves can be elusive. They do not always present themselves neatly. They are often intertwined with memory, circumstance, practical realities, and the stories people tell themselves about what has happened to them.
And so I find myself returning to a question that I suspect I will continue asking for a long time: When respondents describe how they feel, are we hearing the emotion itself, or are we hearing their interpretation of that emotion after it has been filtered through memory, meaning, and experience?
I don't know that there is a definitive answer. But I do think it is a question worth sitting with.
