The media is a powerful instrument. Over the years, it has become clear that the power of this medium is such that major changes in the future direction of legislation can be influenced in any number of different directions. The pediatrician is increasingly familiar with the power of the media, yet is often unwilling or feels inadequate to actively take advantage of it to use it to promote a legislative agenda for which he (or she) believes. This article presents concepts and ideas that can be used by the pediatrician to promote issues in the direction so desired. Many of these ideas are derived from personal experience with the media and reflections on both the positives and negatives that have occurred over this past decade of my experience. Having been the pediatrician for WNBC's "The Today Show" for 4 years and having had the opportunity to be a pediatric on-air consultant to our local television network, I have made more than my share of gaffe and misspeaks. It is my intent to use them to help you from falling into some of those same traps.
In a superb article titled "The Role of the Pediatrician in Violence Prevention,"1 the authors point to a framework for working with other groups in an advocacy role which I believe can serve as a cornerstone for all activities when it comes to pediatricians having a positive influence on legislation. Table 1 from that article summarizes three major steps for developing an advocacy action plan for injury prevention. However, the same framework is useful and can be substituted when one considers how to most effectively use the media in any advocacy action plan.
Step 1: Focusing on the Problem
There are many subjects about which we probably feel some passion. Certainly, the state of our children's health collectively as a country's future leaves many unanswered questions as well as frustrations when we sit back and evaluate the priorities of our nations' leaders. Nevertheless, to be an effective advocate, focus is essential. The media opportunities will not permit you to wax (even so eloquently) on a number of different subjects at one time. Pick your issue(s), research them, understand what the key messages are that you want to communicate, and repeatedly make them clear in your presentation. The narrower and clearer your focus, the more information the authence will take away from your presentation. More specific tips regarding techniques for doing this will be given later.
Framework for Advocacy Action Plan*
Step 2: Developing Educational and Legislative Strategies Through Communication
Even though your focus may be clear and your messages may be crisp and understandable, a number of different media can be used when trying to develop a plan to use the media effectively. Radio is effective for some authences, and television is usually very powerful but the access to it and the time for communicating messages may be limited. The "sound bite mentality" has been perfected by television producers, and it is important to be careful in adapting the desired messages to the type of media available. Sound bite mentality is the TV news' desire to look for defined, quotable statements and use them in their videotape or the story, often putting them out of context, and always cutting points of clarification or elaboration one may have originally stated. Print media allows for the greatest opportunity to reach a broad constituency and to present more detailed arguments or explanations for the points you want to communicate. However, you are at the mercy of the reporter to translate what you want said into words that communicate clearly what you want to be understood by the readership. Obviously, the closer relationship you have with the reporter, the more confidence you can feel, but always try to get an opportunity to review what you supposedly said before it goes to press. This is not always possible, but it is worth trying.
Step 3: Evaluating the Effectiveness of the Advocacy Communication Plan
This is much more easily said than done. It is important, however, to remember that many media or communication plans sound good on paper or in theory, but when they happen, no one is quite sure whether it was effective in accomplishing its goals or not. The measurements of effectiveness are also nebulous and often soft. Media consultants or media relations staff often use numbers to justify their efforts. They will try to assess the number of "spots" picked up by networks, the number of clipping services that pick up print articles, or the number of radio interviews. Illese methods may help determine whether the media has transmitted the messages but says nothing about whether the messages have been understood or, in the best of all worlds, integrated and affected a position one way or another. The only measures of this outcome would be to survey and assess change using pre and post surveys. This is unrealistic and probably far too costly.
Suffice it to say that evaluation of effective media communication can, at the moment, only be a "soft" science. Nevertheless, try to use some simple measures of your own ability to use the media effectively. Some of these might be:
* Ask some local expert whether the points communicated were clear. Use parent support groups from your practice or neighbors to evaluate.
* Use media experts to help you with preparation and feedback on your presentations.
* Look critically at your own presentations - either clips of your TV presentations or tapes of your radio interviews - and try to objectively evaluate whether you were effective in communicating your desired objectives.
You are probably your own best critic, and experience and objective feedback definitely will improve future presentations. This is truly one of those skills that can be acquired and can be improved with self-critique.
With some understanding of a broad framework for structuring an approach to the use of the media for furthering a legislative agenda, what are some of the pieces of advice that need to be understood so bad habits can be minimized and your strengths maximized? These are some of my observations over 12 years of experience with different media.
It is most important to first understand who your authence is and to shape the message directed appropriately. There are different types of messages necessary for different groups and different ways of formulating those messages. For example, if the target is to be legislators, committee members, or leaders in Congress, it is important to have the arguments crisply in mind with limited but convincing supporting evidence, and with at most two pages of bullets or substantive points you would like to leave with them including a defined but realistic action plan. One of the most important quotes I will always remember made by Rep Henry Waxman, who was then Chairman of the House Labor and Energy Subcommittee, took place when he was about to hear testimony from an American Academy of Pediatrics (AAP) expert panel. Mr Waxman began the session by exhorting, "Doctor, Fm eager to hear what you have to say but don't tell us what's good for pediatricians, we're interested in hearing what is in the best interest of children." As an overall caveat for all pediatricians who are endeavoring to have some influence on health policy, that quote should be emblazoned in your mental preparatory thoughts.
Even if you are concerned about the impact of work force changes on the training of pediatricians, or on CLIA and its impact on office-based practice, or on health-care reform and the potential prospects of managed care capitated payment and its impact on pediatric practices, the "hook" is to determine and articulate what will be the negative or positive impact on children and families. Certainly, if pediatricians are to be negatively affected by some ruling or regulation, there will be a negative impact on their ability to provide quality care to children, but those arguments must be thought through and articulated.
The same "children's priority" thinking also must be the basis for all presentations to other groups as well, although the language or complexity may need to be altered. Groups of parents from parent- teacher associations will differ from Congressmen who will certainly differ from newspaper reporters.
THE MESSAGE ITSELF
Once you know the authence you will be directing your message to, it's important to focus the message (s) to the several key points you wish to communicate. In general, with television and radio interviews, confining your thinking to three or four key messages is a reasonable number. These key messages or SOCOS (single overriding communications objectives) will be incorporated into your interview/discussion/ presentation at the beginning of your interview and, if possible, summarized and repeated before the interview is concluded. When you construct your series of messages, or tell your story, these points will lay the foundation for the key issues you wish to communicate. Communicating the intended messages depends on several key principles. The first series of principles is known as the three "Cs" of communication, namely:
* communicate key objectives,
* cooperate with the news media, and
* control the interview.
The organization of the messages is also different from the way we are accustomed to presenting. Normally, when we approach a case, we carefully explore the history, perform a meticulous physical examination, perhaps order some laboratory tests, and then develop a differential diagnosis and management plan. This sequential building of our case is the opposite from the way reporters think and the way they like to present material. They think in terms of an "inverted pyramid." They want to hear the conclusion first including the who, what, where, when, why, and how about the position and then comes the supporting evidence. The same construct should be considered when approaching the media when trying to influence legislation or legislators. The authence has a limited amount of time to spend listening. They want to hear succinctly, what it is you want to say and why it is important to them and to your cause. They will be less concerned about the specifics of the supporting evidence or documentation. They will assume that you, the expert, have done your homework as a physician and would not be going public with an opinion or position unless you had done all of the proper background research.
WHAT TO DO WHEN THE MEDIA ACTUALLY CALLS
As pediatricians, we are fortunate to have a superb resource in the Division of Public Relations at the AAP main offices in Elk Grove Village, Illinois. In addition, we also have the benefit of superb legislative guidance from both the central office and from the outstanding leadership in the Washington office. The PR people have developed what they call a "coda of commandments" that serve as excellent background for any presentation to the media on any subject. These "commandments" (Table 2) are useful for legislative agendas or any other series of topics.
PREPARING FOR DIFFERENT MEDIA
Remote News Interview Environment. There are several different types of interview settings that require slightly different preparation and on-camera skills and techniques. The most common interview is the on-site, remote interview by a news reporter who is following up on a breaking or recent news item of interest to the public. The reporter will have called you in the morning or, at most, the day before, and has asked you about a specific item that has occurred and would like to interview you about it. Usually, the reporter will have been given your name by a local organization or the AAP chapter or national organization. Sometimes, they have been referred to you by your local hospital PR staff. The keys to success in these situations are:
* Be responsive to their timetable but don't allow it to compromise your ability to prepare a knowledgeable response.
* If it is not your area of expertise, decline, but try to recommend someone else. It's never a good idea to go before a camera on a subject you are not well versed in. There will be other opportunities.
* If you are being asked to represent your organization or another organization, be absolutely sure that this is cleared and approved by that organization's leadership. Misrepresenting yourself can bring harm to others and hurt your credibility.
* If there are broader, legislative issues that are being asked or referred to, be sure you understand the full implications of them before offering an opinion.
* Have your responses formulated in your mind, with your messages and SOCOS clear and succinct, prior to going before the camera.
* Remember that most remote interviews are on tape. Tape can always be stopped. If while you are being interviewed, you feel uncomfortable or dissatisfied with your answer, simply say "could I start that again." The reporter will really not have any choice but to stop; also, reporters want the best statements as possible as they are always looking for the best sound bites.
* Be prepared for the fact that the interview will probably take an hour or so and that the amount of the interview actually used in the "final cut" will probably be no more than a minute, if you are lucky. Don't be discouraged. Always remember that one good interview begets others, and forming a trusting relationship with a news reporter is important should the need arise where you will need their assistance to present an issue before the public. Keep their name in your files and give them a card where they can reach you at any time should they need you.
News Show (Local or National Morning, Noon, or Evening) or Talk Show. The pressures are greater in this format but the opportunities are greater as well. Usually, you will have more time to make your points, and there will be a greater chance to qualify your answers or add nuances to your responses. This latitude should not, however, permit you to think that you can be fuzzy or loose about your messages. Tightness and clarity are just as important; it's just that you may get the chance to repeat the messages several times or add emphasis to the messages by using individual examples.
This last point is worth emphasizing, for when using the media to influence a legislative agenda of any kind, personal, illustrative examples add significant power to the strength of the position being presented. It's one thing to preach the importance of children wearing bicycle helmets and citing the scientific basis for how, in theory, the use of helmets can minimize head injuries from falls. It is much more powerful to begin with a story of a child who suffered severe head injury from a bicycle injury who was not wearing a helmet and then make your point about what a properly worn helmet could have done. Legislators are people and often parents, and they will identify with a story more than just data charts.
These are some final, practical tips to use on any television appearance, but especially in studio news show settings:
* Relax - do whatever preparatory exercises you have grown comfortable with to relax. As one of my television producer friends told me, remember, it's only television. Our real work (being a pediatrician) is what really matters.
* Prepare those three or four key points and mentally rehearse how you want to say them.
* Anticipate questions. Often in a news show setting, you will have been preinterviewed by a writer or associate producer. Review with that person the kinds of questions that right be asked. That will help both the host and you be better prepared. The better the host looks, the better you will look and the clearer will be the messages communicated.
* Finish your answer. Try not to rush and give succinct but complete answers.
* Look at the interviewer; don't look in the camera or try to "search" for where the camera is. It is the director's job to instruct the camera men how to be positioned. Looking engaged and interested in the interviewer (active listening is the jargon) is always the most effective, on-camera appearance.
* Dress conservatively in a dark suit, solid color tie, blue, solid shirt (for men) and a nonpattemed dress or suit for women. Remove bulky items from pockets. Women should avoid dangling earrings.
* Smile, be animated, and don't be afraid to use your hands in natural gestures that make sense in what should appear like normal conversation.
More important than anything else, look like you're enjoying being there and are enthusiastic about having the opportunity to have your messages heard. Enthusiasm and knowledge about a subject coming from a respected pediatrician are very appealing to the viewing and listening public.
There are more than 4500 AM stations and 2500 FM stations in the United States, and some people (certainly politicians) believe that the influence of radio can be even greater than television. Certainly, the spread of talk radio shows and their increasing influence should have convinced any skeptic that radio must be taken seriously as a potential force in affecting public opinion. If you have an opportunity to be interviewed on the radio about a subject you are interested in promoting, you should take advantage of it. Here are some pieces of advice for being an effective communicator using radio as the communications medium:
* Relax. This is usually not as much of a problem as with television as you don't feel quite as exposed. Even though you might be wearing headphones in a studio or sitting in your own office being interviewed over the phone through a direct hookup to the studio (live or on tape), in general, the anxiety level is not as extreme as with TV.
* Expect a phone preinterview. Usually, the host or the assistant to the host will call you 1 or 2 days before the interview to review the points you want to cover during the interview. Take your time and make sure that the preinterview points reflect everything you might want to say. The host, on air, may very well pick and chose from the list but at least you have been clear about what is die totality of what you would like to communicate.
* Expect tight deadlines. Radio often will want some comments about a topic that is cunent breaking news almost on an immediate basis. If they call and want something now, just say that you can't at the immediate moment but that you can be available in an hour. Take the time, then, to do the research you need and clarify, in writing for yourself, those points you wish to cover.
* Present your background credentials forcefully. Listeners always want to know the credentials of experts who are speaking to them. When providing background to the radio host before the interview, give a succinct but highly credentialed portrait of yourself The most important facts should establish why you should be considered an expert in the topic being discussed.
* When on air, keep your SOCOS in mind, speak slowly and distinctly, modulate your speech with inflections, and finish your answers to questions. I often pretend that I am talking to one person and imagine I am having a conversation with that person. This approach will make your comments sound much more conversational.
You will find that radio interviews, especially when you get a chance to be in the studio, are very enjoyable. They also allow the opportunity to provide a great deal of information in a period of time to a large listening authence.
This is the medium that is the most frequently used by pediatricians and ultimately is the most powerful. The written word, either in magazines, newspapers, or other vehicles, has the most lasting effect because it can always be referred to and quoted. Most often, you will use the print media to more carefully and fully describe a position, a strategy, a series of events that the public or legislators must become aware of, or just as a means of having your opinion about something known. In addition to writing entire articles or pieces yourself, more frequently you will be interviewed by a reporter, be asked to comment on something newsworthy that has taken place, or be asked to give an opinion about something. Just as with the other forms of media, there are certain caveats to help you better shape or influence what actually gets printed. Print media tips to help you use this medium more effectively include:
* Be prepared to have some of the things you say used as quotes. Ask to review those notes in the context in which they will be used when the reporter/writer has finished the piece.
* Don't say anything you don't want published.
* Be sure that you put the most important points first, once again having clarified your messages.
* If you don't know an answer, say so.
* Don't become hostile with the reporter. Most news and media people are really trying to get at the truth concerning the subject. Rarely (in my experience) will a reporter have an agenda of their own that will take over an interview. If you see that occurring, simply return to your basic points and reinforce them.
There clearly are a large number of opportunities to use the media to influence legislation and legislative initiatives. There are a number of examples of legislation or laws that now exist as a result of pediatricians using the media effectively. National requirements for child auto restraints, Consumer Product Safety Commission regulations on children's toys, safety caps on medications, bicycle helmet laws, and increasing restrictions on guns can all be traced, in part, to the timely and appropriate use of the media. North Carolina safe gun laws to protect children resulted from pediatricians using some unfortunate and tragic incidents to dramatize the need for gun control. Highlighting the inappropriate care for children in emergency situations in New Jersey contributed to the movement to enact pediatric emergency care guidelines for that state. Finally, the effective use of the media by the AAP has brought a number of serious, child-related issues to the legislative forefront resulting in improved conditions for children.
It is not easy, though. To use the media effectively takes persistence, thoughtful attention to developing relationships with the professionals in the media, and careful follow-up. It's important that pediatricians speak out on behalf of children and children's needs. The media, when used properly and knowledgeably, can be a powerful ally and contributor to a better outcome.
1. Cohen Dolina J, Kaufer Christoffel K. Reducing violent injuries: priorities for pediatrician advocacy. Pediatrics. 1994;94:638-651.
2. PuWk Relations Handbook. Elk Grove Village, III: American Academy of Pediatrics; 1992.
Framework for Advocacy Action Plan*