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Dr. Smith Goes to Washington


 

Representing hospital medicine on Capitol Hill is an opportunity for physicians to educate policy makers and have a hand in the legislative process. Hospitalists who have had such experiences say that it can also be nerve wracking, eye opening, surprising, and very satisfying.

Rifkin Answers a Call to Arms

William Rifkin, MD, assistant professor of medicine and associate director of the Yale Primary Care Residency Program at the Yale University School of Medicine, New Haven, Conn., started his road to Capitol Hill by answering an SHM call to arms. “SHM was looking for someone in Connecticut to appear before the state Health Committee regarding proposed legislation that sought to regulate communications between hospitalists and primary care physicians,” says Dr. Rifkin, who was also asked to address the issue of whether the use of hospitalists should be mandatory or voluntary.

The call originally came from the Connecticut Medical Society, which—along with SHM—helped prepare Dr. Rifkin for his testimony. These groups’ public policy staffs coached him about his audience, the hearing process, and the key issues. They agreed his approach would be educational and informative in nature. He would explain what “hospital medicine is, the advantages and disadvantages, what is happening now in the field, and the issues being addressed by SHM,” he recalls. “I gave the committee members lots of literature and background information.”

Dr. Rifkin had some challenges to overcome in getting his message across to the legislators. “There is no data showing that lack of communication between hospitalists and community physicians has caused serious problems,” he explains. “I had to explain the difference between factual data and anecdotal information.”

Additionally, he recalls, one legislator seemed skeptical about the hospitalist’s role and kept referring to a health system that mandates the use of hospitalists. “I had to sit back and explain how SHM supports a voluntary model,” he says. “She kept talking about a reported example of a hospital that forced patients to use hospitalists. It was awkward because I suspected that the story was untrue or at least was missing some facts.”

By calmly relating SHM’s position and its reasons for preferring a voluntary model, Dr. Rifkin believes he was able to diffuse some of the tension. After the hearing, he approached the legislator and handed her the literature and statements from SHM. “I offered to stay in touch and suggested we find out about this hospital supposedly mandating hospitalists,” he says “Ultimately, I discovered that this story wasn’t true.”

Making a good impression can help legislators see physicians as colleagues rather than adversaries. “After the hearing, the committee sent the communications bill to the Connecticut Department of Public Health Best Practices Committee. This body was charged with making recommendations on communications best practices,” says Dr. Rifkin, who was asked to talk before this group. In fact, he adds, “They’ve asked me back repeatedly. I’m sort of a regular on the committee now.”

He is honored to have input and to present the hospitalist’s point of view. “Their recommendations likely will be similar to what SHM says regarding inpatient/outpatient communication,” he explains.

In retrospect, Dr. Rifkin believes he made a difference. “I felt as if I brought them some new information and taught legislators some things about hospital medicine they didn’t know before,” he says. “I think I helped them see that it would be counterproductive to dictate the specifics of inpatient/outpatient physician communication.”

When it comes to presenting testimony, Dr. Rifkin suggests, “it is best to acknowledge where legislators are right and use this as an opportunity for education. You don’t want to come across as dogmatic.”

While Dr. Rifkin enjoyed his experience, it was not without some surprises. He explains, “I left shaking my head and marveling, ‘Is this really how laws are made?’ ” He was surprised “about the lack of knowledge about the issues and the willingness to act on anecdotal information.”

Reporting back to SHM, Dr. Rifkin says, “It was good that I was there because—absent that—we could have ended up with some onerous rule that we then would have to undo.”

Another surprise for Dr. Rifkin was how long and tedious the process could be. “I was one of the last speakers on the agenda, and I did lots of waiting,” he states, adding, “If I had been nervous, it would have been a torturous eight hours.” Once he was in front of the microphone, Dr. Rifkin had just a few minutes to get his points across. He then answered questions for several additional minutes. “I had to watch the clock, and it was a little nerve-wracking to try to say everything I wanted to in a short time. But for the most part, it was actually enjoyable,” he offers.

Being active in advocacy efforts is a valuable, satisfying experience, and Dr. Rifkin urges his colleagues to carry the gauntlet. “We need to watch for opportunities to have input on legislation nationally and statewide. Hopefully, we’ll be able to have the same impact we had in Connecticut in other states as well,” he says. “Physicians need to be willing to get involved.”

I felt as if I brought them some new information and taught legislators some things about hospital medicine they didn’t know before. I think I helped them see that it would be counterproductive to dictate the specifics of inpatient/outpatient physician communication.

—William Rifkin, MD, assistant professor of medicine and associate director, Yale Primary Care Residency Program, Yale University School of Medicine, New Haven, Conn.

Feinbloom: Testimony on the Fly

David Feinbloom, MD, a hospitalist at Beth Israel Deaconess Medical Center in Boston, had only two hours to prepare for his testimony about computerized physician order entry before the Massachusetts State Joint Committees on Health Care Financing and Economic Development and Emerging Technologies. “They wanted a clinician to explain how this system would improve quality and result in cost-saving,” he says.

Despite his lack of preparation time, he was familiar enough with the subject to speak in detail and answer questions. “I was a little nervous,” he admits, adding, “I would have preferred to have time to prepare a formal presentation, especially since I ended up having to write something up afterward for the official records.”

Dr. Feinbloom was one of the last speakers, and this had some disadvantages. First of all, he had to wait for hours. Additionally, “Many of the points I wanted to make already had been addressed. I didn’t get a lot of questions because there wasn’t much left to ask,” he explains.

The biggest surprise for Dr. Feinbloom was that the legislative process “is a little more mundane than I expected. It’s not like when you watch the news, and they have rousing, heated discussions.”

Also surprising was how receptive the committee members were about the issue. “Because part of the funding was coming from Blue Cross/Blue Shield, there wasn’t even any real controversy or debate from a budgetary standpoint,” he says. “There also was a big study showing that the system will pay for itself.”

Like Dr. Rifkin, Dr. Feinbloom believes his testimony had a positive effect. “I think that I brought to bear a realistic, ground-level view. I also brought some clinical examples of where this system is powerful, and I don’t think people realized this,” he says. “One of the senators had diabetes and told me he was surprised about how messy drug delivery in the hospital can be and how computerized systems can help. My examples stuck in his head as something he could relate to.”

Testimony Tips from a Veteran Speaker

Dr. Rifkin suggests several keys to presenting testimony that is effective in a way that is stress-free and results in a positive outcome and an enjoyable experience:

  • Look at yourself as a source of information. Be prepared to be an educator and answer questions about who you are and what you do;
  • Remember that the hearing is not a debate. Be friendly and reasonable; don’t portray the issues as all black and white. Don’t get drawn into arguments;
  • Give legislators take-home materials—a packet or a fact sheet. Include a strong summary up front, and follow up after the hearing with something that reminds legislators and their staff members about what you said;
  • Try to make a connection for follow-up and work on future issues. Position yourself as a source of ongoing information; and
  • Present yourself as an informed, concerned physician with no hidden agenda or ulterior motive.—JK

Seymann: Another Kind of Testimony

Hospitalists don’t have to present testimony before a governmental body to have a positive effect on legislation and make a strong impression on lawmakers. Ask Gregory Seymann, MD, associate clinical professor, Division of Hospital Medicine, Department of Medicine, University of California San Diego School of Medicine. While in Washington, D.C., for the 2006 SHM Annual Meeting, he visited his House and Senate representatives.

“Our goal was to educate lawmakers about hospitalists—who we are and what we do—not to ask for favors or handouts,” explains Dr. Seymann. “Several of us went as a group to our senator’s office, and it was a rather short visit. We met with a staff person, who listened briefly and took our materials but asked few questions.”

When he went alone to his House representative, Susan Davis’ (D-CA) office, Dr. Seymann had a much different experience. The representative’s staff was extremely welcoming. “They told me that she was still in session marking up a bill, but that she really wanted to meet me,” he recalls. “They asked me if I could wait; and eventually they took me over to another building to meet her.”

Dr. Seymann’s House representative met with him for half an hour. “She was very pleasant, and I felt comfortable talking with her. I just gave her the basics of who we [hospitalists] are and what we do. She admitted that she didn’t know much about hospitalists and seemed interested in what I had to say,” he says. Davis asked several questions, Dr. Seymann notes. “She mostly wanted to know about how our practice differs from general internists and the difference between hospital and outpatient-based medicine,” he recalls, adding, “I felt like she heard me. The meeting exceeded my expectations.”

The difference between the two visits was striking. Dr. Seymann explains that it is important to realize that “you never know when something you say will make a difference or have an impact. You have to try and, sometimes, keep trying.”

Follow-up is important for these visits. “I sent e-mails on returning home to thank them for their time and remind them that I would be happy to help on hospital medicine issues in the future,” he says.

While Dr. Seymann believes he helped educate legislators about hospital medicine and the hospitalist’s role, he also learned something himself. “I realized that one person can effectively engage in the legislative process and that Congress is interested in what we have to say,” he says. Additionally, he observes, “They take the input of their constituents pretty seriously, and we have a role to play in ensuring that our voices are heard on issues that affect our patients and our profession.” TH

Joanne Kaldy is based in Maryland.

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