Opportunity, Means, And Motive

David Hill MD, FAAP

“So, Doctor, what are some things people can do about this problem?” If you’ve ever faced a reporter then you’ve probably answered some version of this question. If you had adequate time to prepare, you may have even emailed your advice in advance to provide bullet points for the graphic. This is, after all, “news you can use!” (What would they call it if “news” and “use” didn’t rhyme?)

But do you ever wonder how many people actually do the stuff you recommend? I imagine it depends in part on the nature of the advice. “Keep your children indoors while these wildfires rage,” probably sees a lot of takers. “Be sure and get your child’s flu vaccine this season,” wins some, if not as many as we’d like. “Don’t let your child have a television in his bedroom,” gets...(crickets).

What do we hope to accomplish as pediatricians by engaging the media, aside of course from the fame, fortune, and autograph-seekers we so enjoy? Personally, I hope to extend my mission beyond the exam room into people’s living rooms, where my advice can help children live healthier lives. But if that’s our goal, how can we be best accomplish it?

In the clinic, I know the answer. My career has spanned the transition from a paternalistic model of behavior change (“Of course you’ll do what I say; can’t you see how crisply pressed my white coat is?”) to the awkwardly named transtheoretical model (“So is it okay if we talk for a moment about your habit of sharing cigarettes with your child?”). This transition has given birth to motivational interviewing, a technique that pretty much blows everything else out of the water when it comes to helping people embrace healthier behaviors.

Motivational interviewing is far too involved to fully explain in this space, but the four core concepts are pithy enough to hit. The first idea, “express empathy,” suggests we start by listening to where our patients are coming from and trying to connect, i.e., “I can see how smoking with your child gives you two a chance to bond.”

Second comes, “develop discrepancy,” meaning to help patients see how their current behaviors might lead to outcomes they don’t desire, as in, “You’ve said you wished you could quit smoking. How do you feel about your child smoking?” Third, and most alliterative, is, “roll with resistance,” meaning we must accept that patients’ reluctance to change is a normal part of human nature and not a moral failure, like, “It sounds as though you feel the time you share smoking with your child is strengthening your relationship. I see why you might not want to give that up.” 

This leads to the final step, “support self-efficacy,” a toughie; both because it’s nearly impossible to say three times fast and because it doesn’t just mean being supportive when patients do what we suggest. It means being equally supportive when they don’t, as in, “I’ve enjoyed our conversation today. If we can talk about this smoking thing again some time, please let me know!”

Motivational interviewing isn’t magic, but when practiced one-on-one it has posted impressive results for changing behaviors ranging from overeating to alcohol abuse. The question I struggle with is how to make this face-to-face intervention work when addressing a whole population, as we do in the media. Can we ask what people’s most common reasons are for, say, not vaccinating their kids? (It turns out more parents are worried about pain and fever than about autism.) Can we show empathy for those in our audience who may resist change, citing those reasons? Can we avoid moralistic language when talking about people whose decisions we think are unwise?

I don’t pretend to have mastered the art of translating motivational interviewing techniques to a sound bite that may last well under a minute. I do think, however, that those of us who can pull off that trick will be the most effective medical communicators ever. As for myself, I can live without autograph-seekers. I wouldn’t want them to wrinkle my white coat.

Social Media and Public Health

Jacqueline R. Dougé, MD, MPH, FAAP

Social media has become an important public health tool. It is inexpensive; it reaches millions, and can positively affect behavioral change. However, for the busy pediatrician it can be hard to stay abreast of all the new and beneficial tools out there. Below are a few that I have found particularly helpful and innovative.

Healthychildren.org is a website developed by the American Academy of Pediatrics to provide health information to parents. Parents can search for pediatric providers, get answers to health questions or look up health topics. It is a great resource to link to your practice’s website and to share with your parents.

Text4Baby recently celebrated its one year anniversary. It is a project of the National Healthy Mothers, Healthy Babies Coalition; the American Academy of Pediatrics is among its many partners. Text4baby provides free health information to pregnant and new mothers via free text messages. The messages coincide with a woman's due date or the baby's date of birth. Moms receive information on topics such as breastfeeding, immunizations, safe sleep, nutrition and smoking cessation. Mothers are also connected to community services. This is a great resource to refer new parents.

The National Association of County and City Health Officials (NACCHO) recently developed a campaign to promote the Vaccine for Children’s Program (VFC). VFC is a federal program that provides free immunizations to millions of children enrolled in Medicaid or who are uninsured. The campaign promotes the program and educates parents as to how they can access vaccinations for their children.

Health and Human Services (HHS) launched a website, InsureKidsNow.gov. This site increases awareness about what programs are available across the country for uninsured children and helps parents enroll their children into affordable health insurance plans.

Lastly, the First Lady’s Let’s Move Campaign uses social media to prevent childhood obesity. The site is bringing together health care providers, parents, children and industry to find ways to promote healthy eating and physical activity.

These social media campaigns not only promote but improve the public’s health. They illustrate how the field of medicine and public health are changing. It is an exciting time to be both a pediatrician and public health professional. Personally, I like to think all pediatricians are also public health professionals and as such it behoves us to familiarize ourselves with the tools and campaigns out there and to share this information with our patients. Social media is a great tool to promote health and improve health behaviors.

To learn more about current social media campaigns and about social media in general, check out the The Centers for Disease Control (CDC) website or the May issue of AAP News.

The Perfect Pitch:

By Alanna Levine, MD FAAP
Developing a pitch for a television segment is not an easy task. You have one chance to pitch the segment to a producer, so it pays to make it a strong one. Producers scan through hundreds of emails every day-some they read and some they don’t even open. How do you make your pitch stand out, get read, and ultimately get picked up?

I have been pitching stories to the media for three years. I have developed relationships with many producers and have been lucky enough to get feedback from them on my pitches. The following are tips I have picked up along the way that help maximize the chance that my pitch will become a segment.

1. Develop a one line ‘tease’: Try to create the headline for the show in the pitch. What would the hosts say is coming up after the commercial break to keep people interested and prevent them from turning the channel? For example, “Spring Break Safety Tips: 5 things every parent should know to keep their teens safe while away on Spring Break” or “Is your baby safe in the car? A new study shows that only 20% of babies are buckled in properly. Find out how to make sure your baby is protected”
2. Be succinct: Producers don’t have that much time to spend on any one pitch. Put the most important points in the first lines of the pitch. Limit the pitch to one paragraph or a few bullet points. If they are interested, you can always provide more information later.
3. Give the story a hook: Why should it be in today’s news? Relate it to something that happened recently. For example, the week Michelle Obama launched the “Let’s Move” campaign was a great time to pitch a story about the importance of diet and exercise in kids’ lives. If a child was recently injured in a sledding accident, pitch a story about guidelines parents should follow to make sure their kids are protected.
4. Make sure the segment is timely: Pitch backpack segments just before back to school time; pitch segments about the importance of flu vaccines in the fall when they hit doctors offices; pitch fireworks safety just before July 4th.
5. Pitch when the pitch will be best received: Do not send your pitch to a producer while the show is live on the air, or during the hour it tapes-it will only get buried in his/her inbox. Try to find out the producer’s schedule. For example, the CBS Saturday Early Show's medical producer is off Mondays. Each week early Tuesday morning, I scan the health news headlines and send him a pitch before 10 am. He usually emails back feedback within the hour. Catching a producer at the right time can make all of the difference.

And lastly, don't be shy about pitching. Remember, producers cannot come up with all of the segments on their own. They rely on experts to present them with great ideas.

Being A TV Medical Expert: Tips to get asked back

Being asked to appear as a guest medical expert for the first time is an exciting experience. How do you ensure you will be asked to come back on the show again? The following are a few tips I have picked up along the way:

1) Arrive early. The last thing the producer wants to do is worry about whether you are going to make it to a live appearance. It's better for you stroll around the neighborhood and collect your thoughts on the topic for a few minutes, rather than run the risk of receiving panicked phone calls from a producer.

2) Be courteous from the moment you enter the building. Smile at the security guard, be friendly to the intern or page who escorts you in the building, and make small talk with the people in the green room. Not only will it make good impressions, but you will appear relaxed and confident. Often times, the make-up artist or others in the green room will ask what you are about to talk about…it's great practice to speak your thoughts aloud, so be sure to use the opportunity. Just remember that what's spoken in the green room may be repeated in public.

3) Ask ahead of time if you need to arrive camera-ready. Some shows will have a stylist on set to do hair and make-up, others will expect you to arrive camera-ready, and some will have someone ready to touch up what you have applied ahead of time. It pays to ask before you arrive. Additionally, I recommend that the ladies always carry some make-up and hairspray, in case you get stuck in traffic and don't have time for the full stylist treatment. Gentlemen, I encourage you to accept the offer of face powder. Distracting shine can take attention away from your good messages.

4) Discuss the segment with the producer ahead of time. Some producers will want to pre-interview you on the telephone, while others will want you to email 'talking points' in advance of the show. Either way, make sure you have some contact with the producer ahead of time, so you know what to expect and aren’t faced with any surprises on camera.

The producer will ask you about the topic you will be discussing so before you speak with the producer take a few minutes to do a quick internet search, even if you are well-versed on the topic. One great resource is the AAP "children's health topics" page on your topic at www.aap.org. A small bit of mental organization goes a long way in making you sound like an expert who can convey a lot of valuable information in a short period of time.

While on the phone, ask the producer if he or she would like you to email formal ‘talking points’ for the show. If so, send these in Q&A form. Even if the producer does not desire ‘talking points’ from you, creating some for your own personal use is a fantastic way to prepare for the segment.

Issues to ask the producer about include duration of the segment, who will be interviewing you, what to expect when you arrive at the studio, and whether hair and make up touch up are provided.


5) Be flexible. Things frequently change in the broadcast world, and they can change last minute. I have had a topic change upon arrival at the studio, leaving me only 10 minutes to review the topic on my i-phone. Though this would fluster almost anyone, try not to let the producers know you are uncomfortable about a last minute switch. The more easygoing you are, the more likely they are to have you back. And, unfortunately, we all get cancelled. Sometimes it's the day before, sometimes it's the morning of, and sometimes it's even after sitting on the set. I personally have been sitting next to the interviewer with my microphone on, only to have my medical segment bumped by someone talking about vegetarian turkeys for Thanksgiving! But don't give away your annoyance, even if you (ahem) changed around your whole schedule, only to have the segment be canceled at the last second.

6) Be reachable. Immediate access to email is a must. Often you will receive an appearance request in the form of an email. If your response time isn't quick enough, you risk losing the opportunity. A blackberry or i-phone really comes in handy if you plan to appear on air often.

7) Send a quick thank you email. It's always nice to send a brief "thank you for having me" email, and it gives you an opportunity to say that you would love to come on again if the need should arise. Many times this has opened the door for me to send pitches back to the producer.

By: Alanna Levine, MD, FAAP

The Nation's Doctor

As Surgeon General, from 1998-2002, Dr. David Satcher described his role as the “Nation’s Doctor”. In 2007, he testified before Congress stating in part, “I believe that it is the responsibility of the Surgeon General to communicate directly with the American people….” (Committee on Oversight and Government Reform The Surgeon General’s Vital Mission: Challenges for the Future Testimony by David Satcher, M.D., Ph.D. July 10, 2007.) Surgeon General nominee, Sanjay Gupta has already proven that he can communicate with the American people. The prevailing argument however, is that it takes more than a reporter to be the Surgeon General. His first challenge will be Congressional approval. After approval, Dr. Gupta will likely spend the majority of his time winning the support of those who believe he is not qualified.

Only two of the last eleven Surgeon Generals are easily remembered: C. Everett Koop and Joycelyn Elders. C. Everett Koop was Surgeon General from 1982-1989. He is a Pediatric Surgeon and continues to make television appearances. He was very public during his service and fit the stereotype of what most Americans associate with wisdom and experience. The Surgeon General warning labels and C. Everett Koop are synonymous in the minds of Americans who witnessed the obscure office become a very public platform. The second memorable Surgeon General is Jocelyn Elders who was Surgeon General from 1993-1994. She is a Pediatric Endocrinologist and created a media firestorm with comments about masturbation. Her firing began a rift in the perception of what the Surgeon General should promote. Public health advocates and political conservatives do not always agree on what message the Country should hear.

These two examples demonstrate contrasting communication styles and media experience. Media knowledge is a vital skill for an effective Surgeon General. It is this role as the “Nation’s Doctor” and his ability to communicate that illuminates the choice of Dr. Gupta for Surgeon General. Dr. Gupta is a neurosurgeon who has already become a trusted source of information for millions. However, he may not have the support of many in the scientific community or the Public Health Corps, which he would oversee. As with many institutions, experience is the currency that pays the dues. Other physicians also look at the choice as a threat to public health and primary care because he is a sub-specialist without a Public Health degree. The past eleven Surgeon Generals have had specialties to include neonatology, family medicine, nephrology and veterinarian medicine. The current acting Surgeon General Dr. Steven Galson specializes in Preventative Medicine and Occupational Health. Dr. Gupta’s credentials as an expert in neurosurgery confirm his ability to practice medicine. His success in public health would depend on taking full advantage of the vast resources at his disposal. If Dr. Gupta utilizes the scientific and medical advise of experts to analyze the evidence and then, uses his skills as a communicator to direct the National health goals he has the potential to be one of the best remembered Surgeon Generals in a generation. Imagine 15 year-olds talking at lunch, “Dr. Gupta said, ‘Ephedra can kill you.”

The Office of the Surgeon General may be poised for the spotlight and focus America’s medical needs toward the best care practices. Or it may become another distraction from important issues. We may see how ready for change everyone is and how an effective communicator can make a difference.

by
Jeff Hutchinson, MD, FAAP, FSAM
COCM Website and Blog Editorial Advisory Committee Member

Question Of The Month: Getting Ideas for Media Work

Media Question #2:

If you do media work such as write a column, article, blog, do TV or radio show, where to you get your headlines or ideas?

A: Headlines: national or local

B: current AAP journal articles and themes

C: the producers or editors give them to me

D: what I see in my practice

E: other – please specify

Here are this month's responses:

"Most of my topics for articles either come from the AAP / journal searches that I find interesting or from the reporters themselves. While I find the stories that I do from the articles I find to be more interesting and satisfying, I don't have a lot of time to pitch story ideas. Thus, I also respond to reporter's ideas more often than I would like."

"A and D: I get my headlines from the NY Times or Chicago Tribune. Patients are the best source of questions and usually answers. It adds the personal touch to the discussion."

"As my blog is for Residents and our local EMS providers, I tend to stick with topics related to what we are seeing in the ED. The saying about things "happening in 3's" is very true where I work! I often incorporate hot topics or seasonal items into the discussion."

"I do a local cable TV interview show called "School Health news' I get my ideas from my knowledge of school Health' and Current AAP Policies."

"All of the above. I read other blogs, columns; listen to talk radio. Then I research and write my editorials or columns. My essays are from my practice."

If you'd like to contribute your answer to this question, email me!! gsokeeffe@aap.net or cocmeditor@pediatricsnow.com

GENERATIONAL GAP OR INFORMATIONAL GAP?

Today's blog is by COCM member Mark Rosenberg M.D., F.A.A.P., from Children's HealthCare Associates in Chicago, Illinois, who writes:

"As recently as two generations ago, when a new parent needed advice on the care and raising of their newborn, the trusted source of information was a grandparent or other close relative. Now the ‘trusted’ source of information is the internet and the various information services available on line. While we owe a great deal to the information revolution on the internet including rapid access to information including libraries of journals that would have required a trip to the university library, there is much to be wary of. Information may be posted by literally anyone, who then becomes an instant expert.

A case in point of the information revolution is recent access to information on vaccines; particularly the celebrity endorsed alternative approaches to immunizing infants. Despite numerous medical studies and epidemiologic research in the safety of vaccines, as well as a track record of reduction in vaccine preventable disease, members of the public have chosen to accept anecdotal stories of alleged harm caused by vaccines. The result has been lower rates of immunization in many areas of the country and the potential for susceptibility to diseases that most pediatricians and emergency departments rarely see including invasive pneumococcal disease and Haemophilus meningitis.

On line parent groups provide another source of information to parents, not unlike the backyard fence that my parents used to chat with neighbors, except that the sources of information are unseen and anonymous. These groups have become sources of health information as well as information about specific physicians. Once one of the physicians in my group acceded to parents’ requests to provide an alternative immunization schedule, she was subsequently identified as the physician to go to, despite not seeking out that role. Word of mouth[on line version] has changed her image and practice. A similar source of information is the blog, an online discussion group frequently within a media source web site. This use of the parent to parent information exchange may have the perception of official sanction when conducted by an ‘official’ media source, such as a newspaper or magazine.

For pediatricians, the challenge is to adapt to the new informational age by convincing families to use validated sources of information and rebuild the confidence in physicians as reliable health care providers. Beyond accurate information medical groups must maintain credibility without conflicts of interest in our relationships with the pharmaceutical industry and vaccine manufacturers. Grandparents play a role in discussing their past experience with vaccine preventable disease. Families need to hear our strong voices as advocates for the health of their children."

Do you have a blog post you want to share with COCM members on media issues? Email me at gsokeeffe@aap.net.

Preparing For A Media Appearance

When you get a call from the media for an interview, how do you prepare? What goes through your mind?

COCM member Dr. Vandana Bhide, an internist and pediatrician in solo practice in St. Augustine, Florida, was called by the media recently about a situation in her community and shared with us her media lessons learned. She writes:

"Recently, I was interviewed by the CBS affiliate in Jacksonville, Florida to on a story about a local 14-year old girl who almost died of alcohol intoxication after attending an underage party. Here are some things I learned from my media experience:

1) Research, Research, Research. Even though I have spoken at town hall meetings and other forums for the public regarding the medical effects of alcohol on children (I am on the board of a local substance abuse counseling center which also runs a number of in-school alcohol and other drug abuse prevention and intervention programs), I felt so much more confident and calm when I had some time (OK, 30 minutes, tops, but better than no time at all) reviewing the important points I wanted to make about the topic. Even though only 10 seconds of it got on the air, it made for a more interesting 10 seconds!

2) Expect the Unexpected. When the reporter called me to meet for the interview, she asked me to meet her at the “Real Jail” (as opposed to the pretend jail???) After unsuccessful attempts at trying to find “Real Jail” under the “Points of Interest” section of my GPS and then also failing to find this location on Mapquest, I finally resorted to the old-fashioned technique of asking a policeman for directions. I finally figured out that the reporter was referring to the adult jail, not the juvenile detention center. When I saw the segment air, I realized that the reason the team was reporting at the jail was that three people had been arrested in conjunction with the underage party.

3) Be Humble. I gave the interview at 5 PM on a Saturday, and the segment was scheduled to air on the 6 o’clock news. I was told that the piece would probably be bumped off the 10 o’ clock news because of the approaching thunderstorm. You may think that your “expert” opinion is important, but maybe it isn’t in the big scheme of television news. Lesson learned: Weather is Important. Especially on the Atlantic Coast of Florida. Especially during hurricane season. Especially during a perfect golf weekend. I guess there wasn’t any breaking weather news because the segment did indeed air again on the 10 o’ clock news.

4) Generate interesting questions and answers. The only question the reporter asked me was, “Should parents speak to their children about alcohol?” The answer seems obvious, and yet studies show that the vast majority of parents don’t speak to their kids about the importance of refraining from alcohol and drugs. So I tried to avoid answering with a brief yes/no question and instead explored what are the barriers to parents and kids having this discussion.

5) Speak in English. Seems obvious, doesn’t it? But how many of us have been guilty at some time or the other of speaking in medicalese? Do television viewers understand that “the toxic effects of alcohol include bradycardia and other arrythmias, respiratory depression, hypotension and death by aspiration?” If the explanation is not easily understood, you may find your segment on the cutting room floor!"

COCM Members In The News

Here's some of the latest media appearances of COCM members:

• Ari Brown (Star Ledger: Autism)

• Deborah Mulligan (Star Ledger: Dry Drowning)

• Deborah Mulligan (Washington Post: Dry Drowning)

• Linda Reid Chassiakos (Editorial Daily News)

• Linda Reid Chassiakos (Editorial Daily News)

• Gwenn O'Keeffe, MD: Dr. Anonymous Radio Show

• Gwenn O'Keeffe, MD: Vicky and Jen's Radio Show

• Jo Ann Rohyans, MD was on CBS affiliate Ohio (WBNS-TV) on Tuesday, July 8 discussing HPV

• Robert Mendelson, MD discussed HPV for "Scribe" a monthly publication for the Medical Society of Metropolitan Portland in early July

• Richard Baltz, MD, Newborn Colic, Newsweek

• Thad Woodward, MD hosts for Line One - Your Health Connection, KSKA, Anchorage, Alaska

Question of The Month: Preparing For Media Calls

Media Question #1:

When the media calls you for an interview on a child health issue or a breaking headline, what do you do to prepare for the interview? Do you

A. A. Consult the AAP

B. B. Consult medical colleagues

C. C. Do a web search for information

D. D. Just do the interview cold because you know the material so well

E. E. Other: please specify!

Here are some of the answers I received from COCM members:

• "When the media (TV, radio or print) calls, I usually put together my thoughts and then check the AAP website and links to verify facts/add statistics to my presentation."
• "I do A, B and C"
• One COCM member who does a great deal of media wrote:

"A. Consult the AAP--I call Susan Martin or Debbie Linchesky in the AAP Media Relations office if I'm not sure of the AAP's position or a certain angle to take with a topic

B. Consult medical colleagues--I often talk to pediatricians in my office and other AAP media spokespeople just to get a reality check and see if there's something I haven't thought of yet.

C. Do a web search for information--I check the AAP web site for policy information as well as parent guides (these make good links for reporters/consumers). I also like medlineplus.gov and emedicine.com for general medical information.

D. Just do the interview cold because you know the material so well--almost never; even if I know the material like the back of my hand and have done an interview topic many times before, I like to refresh my memory, even if it's just a little bit.

E. Other: please specify! If there's time I try to get a little background information about the reporter or publication/web site/TV station etc. to search for other common ground. (For example, I might be able to say "I really like that story you did on pool safety" and comment that the AAP has new information out about summer safety in the Press Room part of the web site or mention a foundation I've heard of that teaches swimming and drowning prevention to low-income African American kids.) I also figure out what kind of stories they do and then pitch them an idea or two for future topics. This can help keep you relevant as a source."

If you have opinions on this question, let me know and I'll add your answers to the mix! You can email me at cocmeditor@pediatricsnow.com