Ten Suggestions for Survival and Effectiveness When Educating Physicians About Topics They Dislike
Mark P. Pfeifer, MDUniversity of Louisville School of Medicine
An Objective View
a formal set of policies, procedures, and regulations to prevent, discover, and correct fraudulent billing of Medicare
A Physician’s View
a tedious, arbitrary, and unrealistic compendium of stupid rules, made up by mindless bureaucrats who have never practiced medicine, designed to waste my time, threaten and punish the innocent, and undermine my profession
#1 Leave the pulpit at home
#2 Data not Dictum
I come from a state that raises corn and cotton and cockleburs and Democrats, and frothy eloquence neither convinces nor satisfies me. I am from Missouri. You have got to show me.
Willard Duncan Vandiver, 1899
Convincing Physicians of the Value of Compliance
Authority is neither necessary nor sufficient for power
Power comes from using data fragments to change other’s perception of you and the task at hand; physician’s love, and therefore respond to, data
(gentle) arguments: reduce their risks, taking the higher ground, value added services, save them money
Example Data Fragments
“The FBI had a 150% increase in fraud investigation budget in 1999”
“This is Janet Reno’s #2 priority” “The government gets $23 for every $1.00 they
spend in health investigations” “The University of XXX just paid 7 bizillion
dollars” “Here’s a copy of the signature page of the
University of Pittsburgh’s settlement”
#3 Promote Adam Smith’s Enlightened Self-Interest
Nirvana: They are convinced...
The program is theirs The consequences are theirs You’re there to assist and guide them
Influence (power) is the ability to get people to perceive that given behaviors are the best actions they can take in the service of their values
#4 If it is clear they are dying… Be a hospice worker not a surgeon
#5 Park it in neutral
#6 Don’t just do something… stand there.
The Leader and the Lieutenants
Leader must be respected, have tenure, have power, and known to rarely use it
Lieutenants: clinically active, specialist champions, take some blame/heat, defenders of reason
Physicians respond better to other MD’s; better yet, of the same specialty
#7 Spot your 800lb gorillas early
#8 They gotta eat sometime
Thoughts on Effective Communication to Physicians
Prepare to listen Defer impossible
one-on-ones Run short,
organized meetings
Keep it pragmatic Multiple small hits Use humor, avoid
sarcasm Attracting agendas Lunch, existing
meetings
#9 Pick a style, any style
Authority is an expensive, limited, fragile, temporary privilege to engage in certain behaviors with the hope of being backed-up in those behaviors.
Charles Dwyer
Select a Style
Tell Sell Test Consult Consensus
Group's Power
YourPower
#10 Take your own pulse
Physician Behavior
Expecting physician reaction is half the battle - forewarned is forearmed
Take you own pulse - never react back or you replace HCFA as the evil opponent
Difficult Physicians
Obstructionists– omission technique - go around not through
Antagonists– isolate– try to get to real issues– last resort - higher authority
Potential power > real power - use judiciously
#11 PEACO… but not a naïve one
Prayer of Serenity
God, grant me the serenity
To accept the things I cannot change,
Courage to change the things I can,
and wisdom to know the difference.