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This article was published in Hospital Decisions 2005 by Sovereign Publications Ltd.

Keeping on message

John Illman, John Illman Communications, London, UK

Imagine you are a world authority on the evolution and spread of MRSA clones and that you have just been appointed to head the Department of Biology and Biochemistry at a leading European university. You are not due to start the job for another month, but a TV science correspondent calls over the weekend seeking an interview about a new MRSA development.

You have never been on TV before and never had any training in how to present your case to a journalist, but you pride yourself on your communication skills. You really do know your subject and have lectured all over the world.

In the studio, you find yourself competing for air time against an earthquake in Chile, a world summit at the United Nations, the death of a Hollywood star and arms negotiations in Geneva. You have only two minutes on air and feel upset because you make every possible effort to answer the questions – and try to explain the complex background to the story.

But the correspondent isn’t interested in this. Moreover, you spend so much time answering his questions there is no time for what you want to say. He has a different agenda. What will your new colleagues think?

This is a common experience. Effective media communication means turning what you do normally on its head and forgetting conventional structure – 'beginning, middle and end'. A news story will almost invariably begin with the 'conclusion'.

There is a good reason for this. If every news story included background information of the kind many scientists provide by way of introductory information for colleagues, we would need wheelbarrows for our daily newspapers and the average broadcast interview would run to 10-15 minutes. Enough news already arrives at any large newspaper office or TV or radio station each day to fill four or five fat novels and flood news columns and air time several times over.

Thus, the interviewee needs not only to know his subject, but to know how much the audience needs to know. Think of this page as representing the sum total of your specialist knowledge. Now take a pin and insert it into any one of the words of the last sentence. That tiny pinprick of knowledge will probably represent all you need for a typical consumer media interview.

For example, take a TV interview with a haemophilia specialist broadcast by the BBC in the UK about a 12-year-old boy who had a blood transfusion from a donor with Creutzfeldt-Jakob disease (CJD). The interview ran for two minutes 20 seconds (452 words). The doctor had 238 words to explain 'this terribly distressing case'. (By way of comparison, this paragraph contains 80 words). His problem was compounded by interruptions and the need to correct the interviewer twice.

Communications or media training is designed to identify which pinprick of knowledge you need for a particular audience. Consumer audiences, for example, will want to know about the benefits of what you are talking about, and will be less interested in the features. This critical distinction between features and benefits will become apparent when you think how you react as a consumer.

For example, your interest in a new oven will be restricted to the benefits it produces in terms of cooked food and what it looks like. You will probably not be interested in its features, such as how the gas gets to the saucepan or how the designer varied the intensity of the heat.

A typical media training programme includes:
· Introductions: participants describe their media perceptions and experience
· How the media operate and what makes news?
· Key messages and sound-bites
· Preparing for an interview
· Filmed interviews with participants, followed by analysis.

The introductory session

Most participants feel nervous about 'performing' in front of colleagues. Training can actually be more nerve-wracking than a live interview in a TV studio or outside a hospital, but this session usually helps to break the ice and allay fears - though some anxiety is inevitable and indeed desirable.

What makes news?

We all know what makes news, but what about why it makes news? It is not always enough to have a compelling story. News does not occur in a vacuum. Each published story should be seen within the context of the daily news agenda. There will only be so many stories about medical advances or hospital administration on any one day. A story which is 'big' in the late afternoon may quickly become 'small'.

A story I wrote as a UK national newspaper medical correspondent in November 1987 was to have been the page one 'splash', or 'lead story'. In the event the 'splash' was a tragedy which claimed 31 lives – a fire at the King’s Cross railway station in London. My story attracted just five column inches on page 57.

Timing is everything. For example, bowel cancer is of major significance in Europe, but this does not make it newsworthy.

Wanting to break down the taboo of the disease, I proposed writing an article based on an epidemiological study, only to be told that the readers would 'not want to read about bowel cancer over breakfast'. US President Ronald Reagan then underwent investigation for bowel cancer. For two to three weeks, bowel cancer became big news.

The Reagan case provided a so-called 'news peg'. News is about today, tomorrow, last week, this week – not six months ago. Topical appeal can create short windows of opportunity, making news out of topics which may otherwise go unreported.

As so often, it was an individual case history which turned bowel cancer into news, not the disease itself. From the time we sit at mother’s knee, we like hearing stories about other people. Story telling, one of the oldest forms of communication, is deeply embedded in our culture and stories are, above all else, about people.

In the last month, at health and medical communication workshops in France, Germany and London, I have highlighted the importance of the case history in news by referring to a picture most people know – even if they were not alive when it was taken.

It is of a naked little girl running away from the bombs and flames that have just engulfed her village in Vietnam. This is perhaps the best-known war picture of the second half of the 20th century. It is an extreme example, but it is impossible to underestimate the impact of pictures in newspapers and TV (and of 'sound pictures' in radio).

A patient case history is often the central element of a medical science story. The science may become, in effect, little more than the backdrop, even though it is what makes the story. Without case histories, many stories are not published, irrespective of worth. Many patient support groups now prepare patients for media interviews.

Key messages

A key message is a take-home message, ideally short, snappy and simple. Think of 'the elevator test' – getting your message across between the first and third floor of a hotel, when the person you are talking to will get out.

Allow 10-15 seconds or so per message. Stick to two or three key messages in an interview. Key messages can either be simple statements of fact or wrapped up in sound-bites – a short summary of the story. A vivid sound-bite may provide a headline or a broadcast clip.

The paradox is that preparing a key message which is simple as possible, but not any simpler, is notoriously hard and time-consuming. Many scientists and healthcare professionals and administrators spend far more time preparing presentations than media interviews, even though they have significantly more control over the former. Key messages should always be supported by evidence, which again must be briefly summarised.

Preparing for an interview

Most interviewees are 'one-dimensional' and think what’s in it for me? Good interviewees think in three dimensions: What’s good for the journalist? What’s good for the audience? What’s good for me? No, of course, you cannot please all the people all of the time. But one dimensional-thinking is unlikely to please anyone.

Everyday conversation conditions us to answer questions – and, overall, we try and do an honest job. A common error is to treat a media interview like an everyday conversation, even though you know you have only two or three minutes to get your key messages across.

Your time will run out if the journalist has a different agenda to you and you answer the questions in full. You need to take the initiative. 'Bridging' or 'The ABC of Communication' – which stands for Acknowledge, Bridge, Communicate – can help here.

Acknowledge every question even if you do not actually answer it. For example, you may acknowledge a question by saying: 'That’s an interesting point, but I’d like to say…', 'You say that, but that’s not quite right…' or, 'We don’t think that’s the case, we believe that…'. Phrases like these create verbal bridges from which you can communicate your key messages.

Many media training programmes in Europe are run on behalf of international companies or charities. Some attract delegates from several different countries. Others are run for either one person or for small groups of two to four people. The UK is believed to have more media training agencies than other European country, perhaps because its own media is widely regarded as the toughest and most aggressive in the world.

Irresponsible reporting and the constraints of working with the media discourage good potential spokespeople. Let me now tell you my own case history by way of explanation that I know the problem. When I started work as a national newspaper medical correspondent in 1983, The Times decided to make a joke out of my name – a medical correspondent by the name of Ill – man.

The six-line article in the paper’s diary column contained three inaccuracies and reduced my wife to tears. When I telephoned the author to find out his source, he replied: 'Sorry, mate. I picked it up in the pub.' He never thought about checking the facts with me.

This anecdote may confirm all your worst fears - but think of the risk-benefit ratio. Overall, publicity works and generates significant benefit. This is why governments and industry all over the world invest so much money on it. Moreover, what would happen if leading figures in medical science and healthcare were to turn their backs on the press?

The answer was summed up by the London psychiatrist Dr Philip Timms, who warned: 'Psychiatrists should not be discouraged from talking to or writing for the media. If we do not represent our position, it will be misrepresented by the media.'

What he said is as true for any other discipline as it is for psychiatry, but dealing with the media does not come naturally to most people. Healthcare and the media are disparate cultures – as the scientist mentioned at the beginning of this article discovered to his cost.

John Illman runs an international healthcare communications coaching agency, specialising in media training and presentation skills. His advice is based on 30 years' experience in medical journalism, including spells as editor of General Practitioner in the UK, medical correspondent of the Daily Mail, and health editor of The Guardian. JIC provides English-, French-, German-, Italian- and Spanish-speaking trainers.

He can be contacted at:

John Illman Communications (JIC),
9 Grand Avenue,
London N10 3AY,
UK.

Tel: + 44 20 8444 5884
E-mail: johnillman@blueyonder.co.uk
Website: www.jic-mediatraining.co.uk

To order a free copy of Hospital Decisions log onto http://www.sovereign-publications.com

A paper by John Illman, entitled “Preparing psychiatrists for media interviews”, has been accepted by Psychiatric Bulletin, which is published by the Royal College of Psychiatrists. Scheduled for publication in 2006, it describes the principles, ideas and practice underpinning about 20 JIC media training programmes at the RoyalCollege.

All in three minutes

John Illman, John Illman Communications, London, UK

Dr. Gillian Braunold, a London GP, was on camera talking about a new computer project.

Her interview lasted only three minutes. But three minutes is a long time on television if you are competing for airtime against all the demands of national and international news. Three minutes is also more than long enough to get it horribly wrong. The best thing (if you want to be a media doc) is to learn how to use the media before it uses you. Dr. Braunold, of the Kilburn Park Medical Centre, is an accomplished performer who rises to the buzz of the live interview. She knows what the media wants, anticipates the key questions and uses anecdote and image to good effect, keeping things simple.

Wouldn't the money allocated to the computer programme, she was asked, be better spent on hip replacements, coronary artery bypass surgery and nurses' salaries? She took the sting out of the question by acknowledging the need for more money for clinical care and nurses, while highlighting the need for "joined-up care".

Doctors, she explained, needed information at their fingertips. She had just been left in the dark because a hospital letter explaining the change in a diabetic patient's care plan had not arrived.

This interview was not actually broadcast. It was part of a media training programme I ran to prepare GPs, hospital doctors and other healthcare professionals for media interviews. Again, critics may say that NHS money would be better spent on clinical care and nurses' salaries than on media training. But there is a very real need to bridge the wide gap between skilled media professionals and inexperienced interviewees.

It is not enough as a media doctor to " know" your subject. Medicine and the media are disparate cultures. In the media, things are (scientifically thinking) often 'back to front' or 'the wrong way round'. They do not have a logical beginning, middle and end. Take the structure of this article, for example. It follows a classic journalistic format, focusing on an individual and starting, in effect, in the middle - with the action.

In a three minute interview there is little time to be scientific in the accepted meaning of the word. You cannot hope - as many doctors and scientists try to do - to begin at the beginning and end at the end. Conforming to the Alice in Wonderland conventions of the media world does not mean compromising professional or scientific integrity - but it does mean talking "soundbites" or "key messages". Working out these key messages and how best to put them over is what media training is all about.

So what happens in a media training programme? This particular programme involved three participants: Dr. Braunold; Dr. Isabel Shirley, consultant radiologist at Hillingdon Hospital and Dr. Judith Lockhart, of Brent Primary Care Trust.

The agenda included:

· Preparing for an interview
· Interviews and analysis

The interview preparation session dealt with questions like: What do you want the reader/listener/viewer to know, to do, to believe? What makes a good interview for you, for the journalist, for the reader? It is not just a matter of anticipating the questions, but also of anticipating the supplementary questions in the light of news values - and having short, simple answers.

I encouraged people to remember a quote from Pascal, the French mathematician philosopher and pioneer of the soundbite, who wrote: "I have made this letter longer than usual, only because I have not had the time to make it shorter". A common failing in interviewees is not knowing when to stop talking.

Each participant took part in three interviews, one as interviewer, one as interviewee, one as observer. These included: -

· A local newspaper reporter contacts a GP to ask how the programme will affect her and her patients. She wants to know if the NHS can afford a new computer system when there are already so many people on the waiting list.

· A reporter from the medical press quotes evidence suggesting that computer based consultations take longer than traditional ones. He wants to know if the programme will further extend the bureaucratic burdens of general practice, just at the time when people are preparing for the new contract.

Dr. Braunold is not a novice. She has already appeared on TV on behalf of the BMA - and it is easy to see why. How does she regard media training? She said: " Exposure to media training helps not only to focus the mind on the key messages you want to put over, but also to put yourself in the position of the interviewer and understand the difficulties they face with limited understanding of the subject."

Judith Lockhart, the least experienced of the three in media matters, found the day useful as a means of preparing to deal with some of the race relations issues on which she is currently working.

Dr. Shirley said "It enabled me to present the key issues in a simple, direct way which tells a story people can understand, identify and be excited by."