Made-for-TV crisis communication.

There was a controversy about dangerous side effects of a vaccine. The controversy was bogus but that is not the point. The reporter interviewed an anti-vaccine activist whose statements at best were incorrect and at worse lies; however, she was media savvy and very photogenic (well made-up).

Right after her interview the very next shot was an interview with one of the leading vaccinologists and the smartest physician one could think of, who provided a very scientific, detailed and complicated answer and he was not very photogenic (ruffled hair, hurried and almost annoyed).

I said to myself, "My God who are the people going to believe, the short, simple wrong answer given by the well-prepared and good looking person or long, complicated and scientifically accurate answer given by the unkempt professor?"

That day I decided I need to learn how to communicate with the media and I am still learning. In the past 16 years I have given dozens of newspaper and TV interviews and many on sensitive topics and some even in mini-crisis such as the perception of outbreak situation or public health concern.

Media frenzy

The recent proliferation of media outlets has resulted in a growing need for information on every aspect of life. Like many other fields of business health care has to deal with media more and more frequently. But many in health care, especially physicians, are not well-versed or comfortable dealing with media.

This discomfort stems from:

* Fear of being misquoted

* Not having the whole message broadcasted or printed after editing

* Not being given enough time to explain the whole issue

* Being pushed to provide black and white answers to gray areas of medicine

* Inadvertently releasing confidential information 

* "Not looking good" in the media

On top of everything the usual background of communicating with the media is a crisis and anxiety filled situation.

In 2006, for example, we had a tuberculosis exposure at a child care facility that resulted in several children coming down with TB, including one with tuberculous meningitis. This caused great concern in the community. It became important to communicate with the community.

In collaboration with our local health department we were able to send a message of compassion for those children who became infected and their families, a message of confidence that the best people and resources were being utilized and a message of optimism that the outbreak was under control and patients were being treated with an expected good outcome.

The concern about confidentiality is a real one. Early in my career I was faced with a situation where confidentiality was of utmost concern. We had an unfortunate case of a child who was HIV-infected because of abuse. This story made national news. I was the child's physician and I started getting requests for interviews.

I was very concerned and did not agree to be interviewed. Media outlets got my home telephone number and I started getting calls at home. The whole situation was very difficult but the right decision at that time was not to speak with the media.

Since then, however, I have worked with several HIV-infected patients who were willing to go on television or talk to the newspaper and discuss their disease. This has worked well to get the message out.

Communication training

Some concerns arise from the way physicians are trained to communicate. Our training is primarily to communicate with patients.

When physicians communicate they are in control, comfortable in the setting the information is shared, can use as much time as they feel is necessary, provide qualified (gray) information, are the authority figure and have the ability to change what they communicate as additional information becomes available.

That's not the case at all with the media where the physicians are not in control, may not feel comfortable, have limited amounts of time and can't easily change what they communicate.

[ILLUSTRATION OMITTED]

It's especially important for physicians in leadership roles to learn to communicate with the media--and this will also help them to communicate with their personnel in all situations.

Most people are familiar with the usual rules of communication such as being truthful, saying you don't know something when you don't, drawing on others' expertise to address questions not in your area of expertise and being aware of traps.

Physicians are also very familiar with the concept that to be competent in any aspect of medicine requires training. Media communication should not be any different. Many physicians who may not perceive themselves as being in leadership roles and may not feel the need to be adept at media communication may find themselves responsible for communicating with the media.

Several years ago we had a very unusual situation. In a neighboring rural county there were two cases of meningococcal meningitis with one death. About the same time we had one case of meningococcal meningitis transferred from Georgia. As luck would have it, that the next day we had two cases of possible pneumococcal meningitis.

We were participating in a meningitis study and my fellow and I went to the hospital in the evening to enroll these two cases on the research protocol. Within hours it was rumored that there was an outbreak of meningococcal meningitis and the infectious diseases physicians were in the hospital trying to get the situation under control. That was the only time that our hospital's telecommunication system was overwhelmed. There was a lot of concern in the community and rumors were flying faster than warp speed.

Hospital leaders decided to call in the media and hold a press conference. The press conference was handled very ably by our public relations staff; however yours truly was volunteered to answer questions. This was my first scary experience of communicating with the media in a stressful situation. We handled the situation well. My only statement that got play was "There is no need to panic."

It's important to keep in mind that physicians can also use the media to the advantage of their institution and their community.

A few years ago there were an inordinate amount of cases of influenza in our area and this was especially affecting children. Hospitals were overwhelmed both with admissions and in the emergency department. On top of all of this there were reports from around the country of children succumbing to influenza. Coupled with an influenza vaccine shortage, this caused a perfect storm to increase the level of anxiety and concern.

To make it worse one child who was transferred in from out of town with influenza died. We were able to go to the media and tell the community where they could go to get a vaccine if their physician did not have any, and what warning signs to look for if they were concerned about influenza.

Simple rules for dealing with the media Anticipate, prepare, practice

Anticipate the questions from the various stakeholders, prepare the answers and your presentation and practice these (in your mind or aloud)

Show caring and empathy

If your message concerns a serious health problem show compassion and empathy toward those affected. It does not matter if you are talking about something that could potentially be damaging to your institution. Just like our patients, the media and public is first more interested to know if you care before they are going to believe in what you know.

This is even more important in a crisis. The more stressful a situation is, the more important it is for the listener to hear (and even more important to believe) that you are caring, compassionate andempathetic. Competence has greater importance in a low-stress situation.

Show conviction

This will be easier if you have your facts and are stating them correctly. Remember sales people who believe in their product show more conviction than those who don't believe in their product. Big business knows that and that is why they spend tremendous resources in educating and training them about the virtues and value of their products. Recall the last successful sales person you had to deal with. Conviction frequently brings credibility.

Give a message of optimism

Do not manufacture false optimism. State the facts and give hope. There is always hope even in the worse situations. Despair helps no person or situation. Pessimism and negativism will not help the situation at hand no matter what the situation.

3/9/27: Be brief, be clear, and be accurate

Limit to three messages that can be delivered in nine seconds and in about 27 words (fewer if possible). Use short sentences. Remember the debate when Lloyd Benson responded to Dan Quayle, "Senator, I served with Jack Kennedy. I knew Jack Kennedy. Jack Kennedy was a friend of mine. Senator, you're no Jack Kennedy." Two messages: He knew Jack Kennedy, and Quayle was nothing like Jack Kennedy; 10 seconds and 22 words. Those who watched the debate could tell that Benson had anticipated that remark from Quayle. He had prepared the answer and he had practiced it well. Those who did not see the debate can still watch it on the Web.

In usual circumstances people will remember approximately six to eight bits of information. In stressful circumstances they will remember two to four bits of information. People also focus on the beginning and end of statements. Whenever possible support your answers with quartet of facts this are especially important if the question is negative. It takes four positives to overcome one negative.

Use sources who are beyond reproach 

See how politicians always like to use Lincoln and Washington to support their arguments. Who can argue with something attributed to Mother Teresa.

Repeat questions

Do not hesitate to ask for the question to be repeated or clarified if you do not understand. This not only helps you better answer the question but also gives you time to think. Do not feel that you have to answer quickly. Take a moment (but only a moment and not longer), and if you do not know the answer say so.

Watch for traps

The news media love to sensationalize and want you to be a partner in this effort. Be very careful to not to fall in that trap. Compound questions are the most frequently used trap. Separate the parts of the question and answer them separately by identifying that they are two or three questions in what has been asked and you will answer each part separately. Then repeat a part of the question and answer it.

False negative questions are also a trap. Do not repeat false negative questions and do not answer them. Do repeat the opposite of the false negative question if you can answer that question. Otherwise say that the premise of the question is incorrect and move on. Stay on message. No matter what you are asked use "bridging statements" and get back to the message you want to communicate.

A question asking for a guarantee is another trap question. Never guarantee anything no matter how sure you are. Always leave yourself an out. "Never say never, and never say always."

There may be times that you may not be able to follow this rule. If you cannot follow this rule make absolutely sure that what you are going to say is always followed by a qualifier that may allow you a way out if you are wrong.

Finally there is the trap of hypothetical question or "what if" scenario, usually the worst case scenario. This question should also not be answered.

If a question is being asked again, remind the questioner that this question has been asked and repeat the same answer. If the same answer is asked repeatedly, say that you have already answered the question more than once and move on. "No comment" is often interpreted as admission that something is wrong. Avoid "no comment" as much as possible.

Language is critical

Use lay language whenever possible so that you are understandable. When not possible explain the words just as you would to a patient.

Non-verbal communication is critical

We have all heard that "a picture is worth a thousand words." Actually, it's worth many million words. You will be judged on how you dress, if you make eye contact and if you are nervous.

Dress conservatively and wear your white coat if possible, but don't overdo it with a stethoscope, surgical cap, and surgical mask around your neck. Too much paraphernalia may not come out very well on TV or in a photo. Where you interview is important and depends on the issue. Make sure it is a neat and clean. Clutter looks bad on TV.

Use support visuals whenever possible. Low-tech visuals are fine but make sure that you can provide the media with a high-tech version in case they want to use it.

Be available and accessible but always use your media person. They cannot only tell you what the media's issues are but also can protect you when you really don't want to talk to the media.

If someone wants patient information remind them of HIPAA, confidentiality, respect for the individual and their family and the legal aspects. You may also want to make it clear early in your interaction that you will not answer patient-specific. Your public relations person should release the information and you should have a copy of that information or a media release to refer to if needed.

No matter what, never be negative about an individual, organization or the media. In fact, if possible, identify the important role the media can play in the issue at hand.

No matter how well you think you know a reporter or how many times you have worked with her, never consider her your friend or on your side. They are there to do a job and also remember there is no such thing as "off the record."

Finally, remember they are coming to you because they believe that you are the expert. If you are the expert, be confident; if you are not the expert, refer them to someone else or bring the expert with you to answer the questions. Military leaders are very good at this and the Joint Chief always brings his entourage of experts; this gives additional credibility to the answer.

Communicating with the media like any other activity requires education, training and preparation. Anyone aspiring to be a physician leader must be accomplished in this skill and not be afraid of facing the reality of talking to the media.

IN THIS ARTICLE ...

Learn the do's and don'ts for communicating with the media, including some of the types of questions you're likely to be asked by reporters.

Mobeen Rathore MD, CPE 

Mobeen H. Rathore, MD, CPE, is professor and assistant chairman, and chief of pediatric and infectious diseases and immunology at the University of Florida and Worlson Children's Hospital in Jacksonville, Fla. He can be reached at mobeen. [e-mail]

[ILLUSTRATION OMITTED]

By Mobeen H. Rathore, MD, CPE