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.