Introduction
Whether engaged as an on-scene EMS physician, as a practicing emergency physician, as a medical educator-researcher, or working in other capacities, an EMS system medical director may be called upon to interview with the news media, address public officials, or speak to community leaders. In addition to topics related directly to their rapidly evolving discipline, EMS physicians, as highly visible clinicians, often are solicited to render opinions about general medical issues facing the community, ranging from disaster management and environmental challenges to unusual disease outbreaks or day-to-day EMS incidents that become newsworthy or controversial. Often, the EMS physician must do this in a public forum such as a city council meeting or in spontaneous interviews on scene with the news media. In addition, due to its closer proximity to the world outside the hospital and the very public nature of many emergency medical events, the active EMS scene or the emergency department (ED) often becomes a ready focus for public information. Also, because they often constitute the medical leadership for a local community public service, EMS physicians also may become recognized, reliable, and readily accessible sources of medical information for the public. This accessibility often is amplified during weekends and nights when typical medical facility sources and their public information officers may not be as rapidly found. Because of these augmented opportunities for dealing with the media or providing public speaking, the EMS physician should develop special competencies in this unique political and very public arena of medical practice.
The primary purpose of this discussion is to provide EMS physicians with certain tools that may help them not only to optimize their public speaking skills in this unique environment but also to improve their effectiveness in delivering important public communications in general. More than ever before, with the various evolving challenges in the current world, such as diminishing health care resources, unforeseen epidemics, recurring risks of natural disasters, threats of terrorism, and potential scientific or procedural advances in emergency care, competency in public speaking becomes an imperative skill.
When a crisis creates a widespread fear-generating sociological environment, trusted risk communication becomes a critical function for those practicing emergency medical care, particularly when medical threats predominate [1–11]. During such crises, the EMS physician may have a unique responsibility for accurate and fact-based medical risk communication, not only to public officials but often to the public at large. This becomes a very special responsibility that other physicians are less commonly called upon to provide [8–14]. Therefore, this special competency will be required more and more as EMS and disaster systems continue to mature in the future and particularly now that EMS has become a formal subspecialty recognized by the American Board of Medical Specialties. At the same time, these special competencies also will make EMS physicians more effective in their day-to-day communications and routine interpersonal interactions.
Perspectives and caveats about public speaking
Basic assumptions
The recommendations made in this chapter are stated with the consideration of some basic assumptions: that the EMS physician/public speaker is the appropriate spokesperson, and that he or she has received clearance to make public statements from his or her supervisor or applicable public information officer (PIO), either prospectively or just prior to the interview. Particularly during public health threats or major incidents of regional or federal significance, coordination with the jurisdictional authorities and their PIOs is not only wise to avoid confusing messages to the public, but also additional insights can be gained through those preinterview communications.
Likewise, in cases involving specific patients, one should also make sure that the patient and/or the patient’s family has been advised of any public comment [15]. They should be apprised of and agree to the anticipated statements to be made as well as the likely answers to probable media questions concerning the patient’s situation, especially those that may go beyond the typical disclosures that conventionally fall within the “public domain.” Although non-specific communications such as “a 43-year-old man received a severe injury and is in critical condition” may be public domain, generally it is still wise for the public speaker to prepare the related parties for the information to be disseminated in this era of patient privacy.
Most patients, and families in particular, are very reluctant to have any information disclosed. Therefore, it is helpful to point out to them that, in most events that have drawn media attention, the media will report “something” and that the proactive physician spokesperson may be able to help control and minimize the effect of whatever information eventually is disclosed to the public. It is important to recognize that, in today’s world, the media are often more reactive when there is withholding of information. Analogous to a puppy that pulls even harder on a sock when the sock is being pulled away, the more one withdraws from the media, the harder they may look into the issue. More specifically, if they sense an attempt to conceal facts, they are more likely to pursue them more aggressively.
In that respect, no matter what public speaking challenge one encounters, it is crucial that the EMS physician approach the situation as a sincere patient advocate above all else. Self-promotion, insincere advocacy, or indiscriminate information dissemination soon becomes obvious to news media personnel, colleagues, and other patient advocates. Recognizing and appreciating these ethical and sociological concepts, one can become a much more effective, sought-after, and long-lived public speaker. Those simply seeking good “PR” will rapidly be seen as self-serving and not as public servants. Those sincerely promoting patient advocacy, public education, and public well-being, first and foremost, will be seen as true public servants and, in turn, good “PR” will ensue naturally.
The challenges of bite-speak
One of the more common public communication challenges of modern life is the task of finding the right “sound bite.” With the evolution of mass media network teams, worldwide internet communications, and highly reactive information management systems, a massive amount of information is available to be delivered to millions of people. With the expanding availability of information and information sources, and with a growing competitiveness between news organizations as well as a “fast-food” society that prefers “get to the point” news, individual news stories are becoming “bullets” of information. In addition, the news media is a business. Air time or columns of print must be trimmed and “budgeted.”
The continuing success of printed periodicals such as USA Today has been, in part, due to “economies of scale,” in terms of circulation, access, and “efficiencies” of individual articles. Likewise, many cable news organizations also cater to societal demands for bulleted information. In terms of easy access, the more recent proliferation of internet-based news sources now allows a person riding in a taxi in Cairo to get real-time scores of a professional sports competition in California on a hand-held phone device or minute-by-minute election coverage on an office computer. The younger adult population primarily uses these messaged events as a primary source of news and information.
Even more traditionally, the typical half-hour TV news program is actually only 10–15 minutes of news, once one excludes commercials, weather, and sports. To deliver 20 or more news items within that half-hour broadcast, the news producer for that show must keep each story extremely short. Also, stylistically, most network affiliates will still run at least two or three “packages” per show, even during a late evening broadcast. A package usually is a more extended story including a taped segment provided by a reporter. Typically, the package is introduced by the reporter doing a “live shot” from some on-site location or from a desk in the newsroom, followed by the main videotaped story and, in turn, a departing live closure from the reporter, who may engage in some parting chat with the broadcast anchor. Although a package can run longer, it may be as short as 90 seconds and it still needs to include the story set-up, graphics, and several interviews as well as the live introduction and closure. This may leave only a few seconds for each of the individual interviews and less time for other news items. If a quarter or more of the news time is dedicated to packages, then each of the many other news pieces will be even shorter. Therefore, the other 15 (or more) items may be presented in much less than a minute each in formats such as a “voice-over” (voice over tape), in which an anchor reads the narrative while videotape is run, or a “V-O-bite” (voice-over with a sound bite), in which a short interview with a relevant person is inserted.
The bottom line is that interview sound bites must be only seconds long, particularly if there is a need for a “pro” and “con” position format. In the end, one could have been interviewed by a reporter for 5 minutes but what is finally aired, be it on radio or TV, might be only 7–10 seconds. Thus, one should choose one’s words wisely and economically and, most importantly, one should stay focused on the overriding message to be delivered.
Live interviews in certain broadcasts may run longer and may even extend for 2 or 3 minutes, whether on TV or radio. Nevertheless, typically one can expect 2–4 questions. Although the answers may not have to be limited to the 10-second sound bite, they still should be kept relatively brief (under 20 seconds) because listeners often fatigue in terms of attention span when the answers get lengthy. Brevity and “bullets” do it best (see rule #7 later in the chapter).
Whereas brevity and “bullets” are necessary for media interactions, they are just as applicable to other public speaking settings. For example, city council interactions only may allow for a minute’s communication in a less structured presentation. Therefore, one must be prepared to get directly to the point or present relevant arguments cogently and briefly. This concept should not be a surprise to anyone who has sat through lengthy city council or legislative sessions in which hours of tedious comments are made and attention spans grow shorter and shorter throughout a long day of “listening.”
Therefore, the sound bite may not be just a “necessary evil” of modern society, but also an important format for communication in which one is challenged to make a point without short-changing accuracy in order to achieve the communicative objective.
The effective sound bite
Most public communications from EMS physicians are informational, but some also may need to address a point of contention [16]. In the former case (informational comment), a simple “three-part format” (discussed later in more detail) may be effective. A different strategy, however, may be needed for a “persuasive” position. For example, if called upon to comment on a new helmet ordinance for youthful bicycle riders, the public speaker with medical expertise is more effective if he or she can anticipate the opposition’s point of view. In theory, the proponents of the proposed ordinance already should have articulated and disclosed their rationale and supporting arguments [17]. Generally, these have been cited in previous briefings. Therefore, it would be less effective to focus on the “informational” sound bite (e.g. “Up to 90% of all serious head injuries to children can be prevented by bicycle helmets”). Rather, one might want to focus on a strategy of defusing the opposition with a preemptive counterargument.
In the case cited, the EMS physician first may want to ascertain the opposition’s arguments from someone such as an aide of the council member supporting the ordinance. If it turns out that the “con” arguments consist of “we can’t impose a financial impact upon families” or “we can’t interfere with freedom of choice,” the EMS physician may want to recognize those concerns (at the council meeting or in interviews with the media) and, when appropriate, even address them somewhat sympathetically. For example, in the public statement to be made, the medical expert might say, “When I first heard about this ordinance, I had a problem with the concept not only because we could be seen as ‘forcing’ a safety habit upon people, but also because we would be imposing a finite cost upon families less able to afford them. But, as I really looked into it more and more, I became convinced that it makes tremendous sense, both medically and economically.”
That “sound bite” alone could be the main statement for the city council. In fact, more than likely, it will invite further factual comment for the inquiring council or, subsequently, the media. The follow-up then can be the “informational” sound bite in which the medical expert states: “The data are clear: up to 90% of all serious bicycle-related head injuries in children can be prevented by the children wearing a bike helmet. In a way, it’s one of the best ‘vaccinations’ against such disabling injuries that we have – and we have no hesitancy about requiring other vaccinations for our children. Also, for every dollar we spend, we save several dollars in health care costs. So for an incremental additional cost to consumers already buying a bike, we not only protect the community from additional burdens in health care costs, but, more importantly, we are ensuring the safety of our children.”
The media may or may not include the last part of this statement, but they may still use the information as part of their own narrative. Likewise, at the city council meeting, there probably is just enough time to include all of these remarks. In the end, the obvious points are addressed, but so are the counterarguments if they are prioritized and discussed initially.
Three other points should be made about this particular statement to the city council. First, the statements about “cost” may be considered important in helping to defuse the specific opposing position, especially in this particular setting (the council meeting or, analogously, in a hospital boardroom when dealing with some cost-effectiveness issue). Such a tactic, however, may not be as appropriate for the independent media sound bite. In fact, sophisticated media reporters know that the public may not relate to “cost-savings” as much as to safety, and so they may not air or print that initial statement about the ordinance making medical and economic sense. For them the informational sound bite is most important. Nevertheless, in this particular setting, where freedom of choice and taxation anxieties can be concerning, the challenge should be anticipated and politely preempted to help to recruit the undecided council votes.
Similarly, it may be unwise to bring up the “negatives” in the media interview because some people may only hear those points during a brief sound bite and not one’s actual message, thus backfiring on the purpose at hand. Many media consultants even make this a hard rule – that one should not restate the negative issue if a reporter states it when asking a question [18]. For example, if a reporter asks if it is possible to get a disease by doing CPR, it may be less strategic to reply, “While it is always possible to catch a transmissible disease, it is unlikely, and the person you are most apt to save is someone you know or love.” The first phrase may take hold in this instance and that is what the listener actually takes home. Accordingly, even in this day of “compressions-only” CPR, one might simply reply: “70% to 80% of CPR cases occur in and around the home and another 10% to 15% in the workplace; so it’s going to be someone you know or love – and doing CPR may be their only hope.” The persuasive statement may be useful in some circumstances in which negatives should be addressed, but it may be unwise to do so in short media sound bites.
The third point to be made is the issue of what to say on each side of the “but” in a statement. Take for example the verdict yielded by the judge on a typical prime time television drama. During the judicial verdict, the judge usually says something like, “The acts committed here were unconscionable and they go against every ethical and moral substance in my soul. But, the laws are clear in terms of the procedures for proper evidence collection and these procedures simply were not followed. Therefore, I am bound to rule in favor of the defendant.”
The key concept here is that the counterargument starts with the sympathetic statement for the state (and victims/victims’ families of the crime being judged). The true crux of the conclusions comes with the phrases following the “but.” Similar considerations can be seen in day-to-day personal interactions. Take for example statements like: “I’m very sorry I snapped at you – I apologize, but I’ve been under a lot of pressure lately” or “Oh, I really would have loved to be there, but already have something scheduled for that evening.” Both of these statements are more likely to be seen as insincere or, at best, polite responses when one considers what phrases come after the “but.” Transposed, the statements translate more sincerely: “I’m sorry, I’ve been under a lot of pressure lately – but that’s no excuse to snap at you – I apologize” and “Oh no, I already have something scheduled for that evening that I can’t get out of – but I really would have loved to come to your place!” Therefore, in the counterargument or persuasive sound bite (or any other public statement), one should appreciate how to transpose the “pre-but” and “post-but” phrases.
As in the case of persuasive statements, for all the same reasons, the simple “informational” message has to be succinct. As mentioned previously, a “three-part format” might be recommended. First, the sound bite might start with a definitive word or phrase such as “Absolutely!” or “There’s no doubt about it!” or “It depends!” or (as in the previous example) “The scientific data are clear!” After such “definitive” openers, then there should be a short core explanation such as: “90% of all serious head injuries can be prevented by bike helmets.” Finally, a parting resolve (which may or may not be cut by media editors) would be provided, such as: “… in essence, it’s one of the best ‘vaccinations’ against injury that we have!” The exclamation points are placed here purposefully to emphasize the need for an upbeat delivery of those opening and closing words.
If one measures the time required for such a sound bite, it should be about 10 seconds or so. Take for example another sound bite about CPR. If asked whether or not it is important for everyone to learn CPR, the EMS physician might respond: “Absolutely! (opening exclamation) There’s no way a professional rescuer can routinely reach our loved ones in the 4 or 5 minutes in which permanent brain damage can occur if their heart stops beating (core explanation). So it’s up to each one of us to buy them precious time by knowing CPR!” (parting resolve). That entire sound bite is just about 10–12 seconds, if executed well. The video editors may cut the parting resolve, but if said immediately, enthusiastically and with a sincere conveyance of advocacy, it will most likely stay in the final cut.
A minor variation on this theme is to first answer the question asked during the opening exclamation. For example, if asked, “Is it important for everyone to learn CPR?”, the answer might be, “It’s absolutely critical for each one of us to know CPR …, etc.” This approach can be highly effective in terms of reinforcing one’s point, depending on the question. Still, just using “Absolutely!” can work if the question is clear, particularly if brevity is needed.
Finally, when the interview drifts, it is up to the “public educator” to keep it on track. Using the previous example, when an interviewer asks: “What about the chance of getting AIDS or some other infectious disease?”, the interviewee should stay on the mark and state: “Remember: 70% to 80% of the cases requiring CPR occur in and around the home – and another 15% in the workplace – it’s likely to be a family member or friend you will be saving!” (Note: this takes about 10 seconds). Again, the suggestion here is not only to avoid repeating the negative aspects of the question but also to reemphasize to the audience that your own family members are the ones you most likely will be able to help if you learn CPR (your main point overall). In other words, if the question involves words that might flag something that is only a relative concern and a low risk, avoid repeating those words and focus on the communicative objective you wish to make. If there is a true and concerning risk (e.g. drug side-effect), however, it may be seen as disingenuous not to respond directly to the question. So a way to handle this problem may be to respond: “Like everything else, there’s always some risk involved (opening exclamation) but here the alternative is clearly worse. If it was my family, there’s no question what I’d do (parting resolve).”
Dealing with print versus electronic media
Although there is a recent trend toward internet-based news transmission, the majority of older Americans in particular get their news information from the electronic media (radio and TV). Learning how to deal with the electronic media, therefore, should become part of the EMS physician’s repertoire of expertise; however, printed (and internet-based) media can be of benefit as well. Printed media or printouts of internet-based interviews provide a permanent, easy-to-transmit copy that can be reproduced and disseminated rapidly as an attached email file or scanned into a transmissible computer file that can be shown in presentations. Also, print media often drive electronic coverage in trend reports and accompanying blogs. TV and radio “assignments” editors and researchers often tear out stories from newspapers or download printouts of internet-based newspaper reports that encapsulate the focus of information. In turn, they can pass on these “printed” materials (or web-based transmissions) to their reporters for follow-up or even send them ahead of time to interviewees. With hand-held phones receiving this information, this allows the prospective electronic (radio/TV) media interviewee the opportunity to shape his or her response to an evolving story even better. It also allows the interviewees and interviewers alike to rapidly catch up on the issues being examined. Often, the print reporter already has distilled the latest information and gotten the interviews directly from researchers or the source of the story. At the same time, inaccurate information can also be passed along and propagate statements from others who are assuming that information is true. Initial reports of deaths or injuries at an incident may be exaggerated or underestimated accordingly. Therefore, the public spokesperson should always appreciate that caveat and coordinate information with official channels to ensure the public is given consistent information that can be trusted.
In general, print stories (newspaper, internet, magazine interviews) give prospective interviewees more time and information to assimilate their reactions to the subject at hand. Also, the tear-outs, printouts or PDFs can be filed away for future use or sent on to potentially interested parties and stakeholders, including elected and appointed public officials. In addition, important reports that relate to or affect one’s own operations can be sent along to appropriate managers [19]. Likewise, positive stories (e.g. about the EMS system or paramedics) can be disseminated as an “objective” (i.e. someone else’s) viewpoint about the performance of the emergency care staff members [19–21]. Whether the recipients are bosses, city officials, or other “stakeholders” (including the emergency personnel themselves), the print story is readily accessible and readily transmissible [19–21].
One potential downside of print media, however, is that reporters can paraphrase the interviewee’s comments because they are taking shorthand notes (unless they are directly recording it). Occasionally, the quotes may be imperfect. In contrast, with electronic media, the words that are broadcast are obviously the interviewee’s actual words. Although they may be taken out of context or inappropriately edited, they will still be the actual words of the interviewee.
To that end, it is not entirely inappropriate, at the end of the interview, for the interviewee to ask the print media reporter to call back (after writing the story). The object here would be to hear the quotes that might be used and check them for accuracy, and also to see if the reporter really understood the point that needed to be emphasized. First, this means that the EMS physician must be readily available at the “on deadline” time for the possible “read-back.” Second, when doing so, the interviewee has to understand that not all print reporters are entirely receptive to this request. Therefore, it is best to understand that such a request should be made in the spirit of the interviewee’s limitations, not the reporter’s. For example, the interviewee might say, “I know I talked really fast – do you want to go over any point now or call me back later after you’ve had a chance to assimilate all of this stuff? In fact, I’d love it if you call me back to see if I was successful in articulating my points well and you can also double check your facts with me if you want.”
Considering this concept, one also should budget time in an interview session to go back over anything that might need more detail. It would be advisable to be patient and ask if the reporter would like to go over his or her notes to see if anything needs to be discussed in more detail or modified. This is reasonable because most interviewees do, in fact, provide their facts and comment rather rapidly. Therefore, in addition to being available for deadlines, one should also switch gears with print reporters (talk slower) and reiterate certain points if they are key. Reporters want to get it right, but deadlines are often less forgiving.
