The AMA’s $12 million public relations campaign and the ACOG’s Red Alert campaign reach out to the public in organized bids for tort reform. How are neurosurgeons advocating for their patients and their profession?
“The AANS has been laying the groundwork that helps neurosurgeons represent their profession in their communities, in their states, and in their nation’s capital.”
-AANS President
Roberto C. Heros, MD
Neurosurgeons certified by the American Board of Neurological Surgery typically have followed undergraduate education with 10 years of medical study and mastery of skills and technology needed for successful surgery of the brain, spine and peripheral nerves. Little if anything in neurosurgeons’ formal training has prepared these specialists for delivering succinct and informative quotes to reporters, appearing in a television interview as competent as they are in the operating room, or communicating neurosurgeons’ view of policy and legislation to state and national representatives.
Leadership qualities are second nature to neurosurgeons, many of whom are practiced at lecturing on clinical topics, leading a surgical team, and serving on committees of professional societies and academies. However for many, acting in the public arena as an advocate not only for patients, but for the neurosurgical profession, is still a new idea.
At the same time that advancing technologies promise life-altering treatment for debilitating disorders like Parkinson’s and Alzheimer’s disease, communications technologies like satellites and the Internet have fueled an information explosion. With breaking news beamed around the world instantaneously and the media a ubiquitous force, even the most media-shy neurosurgeons may find themselves hard pressed to avoid public comment. Yet this crossroads moment of technological advancement and information saturation also provides neurosurgeons with unprecedented opportunity to arm people with accurate information about how neurosurgeons can help them, why research is important, and what government policy and legislation can best help patients and their families.
What Do Voters Know?
As physicians’ professional liability insurance premiums have increased to crisis proportions-resulting in some doctors practicing without insurance while others retire, modify or move their practices-organized medicine has sharpened Washington advocates’ focus on enacting tort reform. The efforts of many have brought this escalating problem to the attention of Congress, where a liability reform package known as the HEALTH Act of 2002 is pending, and to the attention of top government officials. In fact, President Bush recognized the liability crisis as a major factor contributing to rising healthcare costs in his July 25 address on the subject and at the president’s economic forum on Aug. 13.
Yet for regular citizens, who are directly affected by higher healthcare bills and insurance premiums, as well as by the dwindling availability of neurosurgeons and other specialists, the professional liability issue has scarcely scratched the surface of consciousness. Until recently the national press has barely covered the topic, although in areas where the crisis has proven most virulent, such as Florida, West Virginia and Nevada, the story has received local media coverage. But much of the coverage has cast the problem as a “malpractice” issue, implying that doctors who are doing something wrong are the ones who are affected.
At its June 2002 annual meeting the American Medical Association moved to bring the public into the loop with the launch of a $15 million campaign advocating tort reform. Fully $12 million is allocated for public relations.
In a resolution presented at the AMA meeting, the Illinois delegation called for “campaign-style issues advocacy advertising-both print and broadcast-in select markets and mediums with sufficient repetitions to move an audience to action.” The delegation wanted to target key markets across the country with a focus on national newspapers-The Wall Street Journal, USA Today-selected local markets, and TV spots, complemented by an inside-the-Beltway campaign that would include advertising in print publications like Roll Call (a newspaper for legislators), plus radio spots.
Since June, national media interest in the professional liability crisis has intensified. Recent reports have included “Rise in Insurance Forces Hospitals to Shutter Wards” in The New York Times Sunday edition, and “Malpractice Costs” broadcast on National Public Radio.
Another recent article, “Ob-Gyns Feel Insurance Squeeze Too: Liability Premiums Could Drive Some Out of Delivery Business,” appeared in the Chicago Tribune perhaps thanks to the “e;Red Alert” campaign.
Red Alert Tells Public: It’s Personal
The AMA’s public relations campaign joined that of a specialty severely affected by the professional liability crisis, obstetrics and gynecology. In the May-June 2002 issue of ACOG Today, the American College of Obstetricians and Gynecologists announced the “Red Alert: Women’s Health Care at Risk” campaign to “support members, educate the public and the media about how this [professional liability insurance] crisis is affecting women’s healthcare, and urge federal and state legislators to adopt needed reforms.”
A Red Alert advertisement appearing in Roll Call featured a close-up of a baby’s smiling face and the headline, “Who Will Deliver Your Baby?” The text read:
Skyrocketing professional liability insurance premiums are crippling the nation’s health care delivery system and forcing ob-gyns to close their practices every day. Without affordable insurance, many obstetricians will no longer be able to deliver babies. High-risk patients will be hurt the most. Pregnancy is not the time to be without medical care. America’s mothers are counting on you.
The tag line “Common Sense Professional Liability Reform: Our Top Priority” and the ACOG logo concluded the persuasive piece.
Obviously, the ideas presented in the ad also apply directly to patients in need of neurosurgical care. However, a major public relations campaign to buttress advocacy efforts may be outside the scope of the AANS, which is a fraction of the size of either the AMA or the ACOG. Even so, the association has recognized the important role public relations plays in informing the public about neurosurgery.
But I Don’t Need a Brain Surgeon
Sixty-one percent of respondents to the 1999 AANS Member Needs Survey said that AANS should allocate financial resources to cultivate media coverage of neurosurgery. Seventy-seven percent said AANS should aggressively position board-certified neurosurgeons to the general public. This sentiment likely stemmed from anecdotal evidence suggesting that patients-and some referring physicians-think of neurosurgeons primarily as “brain surgeons” and think of other specialists for treatment of spine and nerve problems like carpal tunnel syndrome.
Osteopathic physicians were faced with a similar identity crisis. Medical Economics reported that when the American Osteopathic Association commissioned a survey and focus groups to gauge the depth of DO’s “perception problem,” they found that 89 percent of respondents didn’t know what a DO was, while focus group participants often associated osteopaths with back and bone doctors. In response, AOA in 1998 launched a three-year public awareness campaign called “DOs: Physicians Treating People, Not Just Symptoms.” The campaign included video news releases, distribution of a newsletter to media outlets, briefings with reporters, editors and producers for national media outlets, and training for the association’s spokespeople.
Neurosurgeons: More Than “Brains”
Many of these elements and more are part of the AANS public information armamentarium. Primarily through its Public Relations Committee, chaired by Ron Warnick, MD, AANS has worked aggressively to position neurosurgeons in the public eye as physicians of choice for disorders of the spine and peripheral nerves, as well as the brain.
“The most direct and cost-effective way to educate the public about what neurosurgeons do is through public relations initiatives,” said Dr. Warnick. “Not only does positive public opinion help to generate referrals for a member’s practice and educate the public about the specialty, but it assists in passing important legislation affecting our members and the patients they treat.”
AANS produced an insert in USA Today that reached five million readers, generated hundreds of media inquires, and thousands of hits on the AANS Web site, taking direct aim at the stereotype of neurosurgeons as “only” brain surgeons in its headline, “Neurosurgery Today: It’s Not Just Brain Surgery,” and lead story on low back pain. It also attacked preconceived notions that neurosurgeons are distant or uncaring by following a real neurosurgeon throughout one day. The piece, which covered James R. Bean, MD, during one of his “operating room” days, revealed the neurosurgeon as an incredibly skilled and caring individual. “You never forget that this is someone’s son, wife, or grandfather,” he said.
The article captures Dr. Bean checking on a trauma patient he had admitted while on call the previous evening; operating on an aneurysm; talking three patients through myelograms; driving to another hospital to perform a surgical spine procedure; checking on angiograms and more patients; and stopping by his daughter’s dance recital-after missing dinner, but before seeing yet another patient. The piece depicted the diverse demands that come with the territory and suggested the attendant personal sacrifice.
Released in the summer of 2000, the USA Today insert still generates interest in neurosurgery and provides valuable information to the public at https://www.neurosurgery.org/aans/nstoday. It is worthy of note that on Dec. 1 the same year, CNN.com published a “day in the life” story on another AANS member, Richard Corales, MD, headlined “A Rewarding Grind: Richard Corales, Neurosurgeon.” A complementary public opinion poll showed that 61 percent of respondents viewed neurosurgery as a “genuinely demanding” field that carries heavy responsibility; nine percent said it “has a lot of mystique and flash,” and 30 percent said “it’s honored for its sophistication but…it’s a lot of work, too.”
Another AANS publication that debunked the “brain surgeon” perception is the National Neurosurgical Statistics report. The report told the neurosurgery story scientifically, by detailing which procedures were performed in 1999 and how often. Out of seven types of procedures, spine and cranial topped the list, with spine performed more than twice as often as cranial. AANS physician and practice profiles, as well as demographic information and a glossary of terms, completed the picture. Available to media and the neurosurgery community beginning in 2001, the report provided solid data for use in articles while generating interest in neurosurgery.
Public Service Is Central to the Message
Bike helmet safety, when to see a neurosurgeon and pediatric epilepsy-subjects that connect with the general public-were the topics of recent public service announcements produced in mat release format. These camera-ready releases, which cover general topics relating to neurosurgery and public health, are attractive to daily press because they are both informative and designed to be plugged into available space on a moment’s notice. Like the USA Today piece, mat press releases are useful for a year or more.
“We’re still receiving clips of published mat releases that were sent to local and national press two and three years ago,” said AANS Director of Communications Heather L. Monroe. She added that besides providing useful information about the nervous system, its disorders and prevention, they create awareness and a positive impression of AANS and AANS members, as well as direct readers to more information on https://www.aans.org.
Bike helmet safety also was the topic of a public service announcement produced as part of a cooperative campaign between AANS and Think First National Injury Prevention Foundation. These advertisements will be seen by millions on the big screen in AMC movie theaters and in national publications including Ladies’ Home Journal and Good Housekeeping. The AANS logo and Web site appear prominently in these pieces.
The World Wide Web is key among AANS’ public outreach efforts. The AANS Web site and the NEUROSURGERY://ON-CALL® site, which AANS cosponsors with the Congress of Neurological Surgeons, support AANS’ public relations projects and help keep AANS and neurosurgery accessible to the public. For example, “A Patient’s Guide to Neurosurgery,” one of the AANS’ patient education brochures, is designed for physicians to provide as a “take home” for their patients, reinforcing physician-patient discussion about what neurosurgeons do and how neurosurgery may help them. This informative piece also is available online to the public at https://www.neurosurgery.org/health/whatis/guide/index.html. In addition, partnerships with other neurosurgery-related Web sites, including Spine Universe and Medem, extend AANS’ outreach by including AANS articles on neurosurgical topics and links to https://www.aans.org.
AANS Works With the Media
Shining a positive light on neurosurgeons by helping the public understand what they do and how they can help patients and their families is a foundation-building activity in which the media is a powerful ally.
The article “Helping the Media Get the Message: AANS Media Campaign Promotes Meeting’s Scientific Research” in this issue details how scientific studies presented at the 2002 AANS Annual Meeting reached more than 27 million people around the world. Actually getting an article published greatly depends on making experts available to reporters for comment and clarification. Public relations consultant and former reporter Doug Levy elucidates the reporter’s viewpoint in “Bridging the Gap Between Science and the Media” in this issue.
The experts AANS depends upon to represent the association’s viewpoint are the members of its Executive Committee. To answer general media inquiries and to serve as experts for the association’s public education and outreach, AANS additionally counts on its Media Information Network, a group of nearly 50 members representing various types of practices and subspecialties who have agreed to be “on-call” when a reporter contacts AANS.
Because an organization’s spokespeople are the cornerstone of effective media relations, it makes sense to provide them with education and practice: media training. AANS conducts a media workshop at every annual meeting. “Media Trainer’s Advice” in this issue discusses some steps to becoming media savvy, information that is presented during media workshops at the AANS annual meetings and, most recently, at the Neurosurgical Leadership Development Conference held in July.
NLDC: Integrating Media and Advocacy
The second NLDC, presented by the Council of State Neurosurgical Societies, took the direct approach to educating neurosurgeons on effective grassroots leadership skills. The conference, which featured sessions like “Grassroots Advocacy Training,” “What’s Happening on the Hill” and “Update on Neurosurgery’s Key Issues” and culminated with congressional visits, clearly aimed to provide every neurosurgeon in attendance with the tools needed to become a neurosurgeon-advocate.
“To transform the future of neurosurgical care, we must implement change in the healthcare legislative and lobbying processes,” stated CSNS Chairman David F. Jimenez, MD. “It is imperative that we continue to expand our influence on Capitol Hill as critical issues in medicine such as EMTALA, HIPAA and professional liability insurance culminate in nothing less than crisis situations.”
New for neurosurgeons attending the NLDC this year was a media workshop. “The heart of effective advocacy is building and delivering a clear and persuasive message,” said Katie Orrico, JD, director of the AANS/CNS Washington Office, who moderated the conference’s sessions. “The media workshop is extremely useful in honing focus on neurosurgery’s message and providing practice in delivering it before it really counts: live on camera or in a meeting with a legislator.”
Washington Committee: Neurosurgery’s Advocacy Nexus
Throughout the year neurosurgery’s advocacy efforts are focused in a cooperative effort of the AANS and CNS, the Washington Committee, chaired by Dr. Bean. Together with the Washington Office, the committee has achieved remarkable success. AANS President Roberto C. Heros, MD, highlights recent accomplishments on the legislative front in his President’s Message in this issue.
With the June 2002 election of AANS member Peter Carmel, MD, to the AMA’s Board of Trustees, neurosurgery gains yet another foothold in the effort to inform policy makers and the public of neurosurgery’s point of view. In “Speaking for Neurosurgery” (above), Dr. Carmel discusses his aspirations for advocacy in neurosurgery.
Neurosurgeons: We Must Represent
From a public relations perspective, every public contact can be thought of as an opportunity to enhance the public perception of neurosurgery. The neurosurgeon is always an advocate for the profession, whether working with an individual patient, the patient’s family, or with a member of Congress.
“The AANS has been laying the groundwork that helps neurosurgeons represent their profession in their communities, in their states, and in their nation’s capital,” stated AANS President Roberto C. Heros, MD. “It is in the interest of our patients and our profession that every neurosurgeon is prepared to work for neurosurgery, sometimes through the media and sometimes on Capitol Hill.”
NEUROSURGERY’S ADVOCACY RESOURCES
Direct links to advocacy information for neurosurgeons
|
Manda J. Seaver is staff editor of the Bulletin.