1. Ten Suggestions for Survival and Effectiveness When Educating Physicians About Topics They Dislike Mark P. Pfeifer, MD University of Louisville School of Medicine

2. An Objective View n a formal set of policies, procedures, and regulations to prevent, discover, and correct fraudulent billing of Medicare

3. A Physician’s View n 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

4. #1 Leave the pulpit at home

5. #2 Data not Dictum

6. 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

7. Convincing Physicians of the Value of Compliance n Authority is neither necessary nor sufficient for power n 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 n (gentle) arguments: reduce their risks, taking the higher ground, value added services, save them money

8. Example Data Fragments n “The FBI had a 150% increase in fraud investigation budget in 1999” n “This is Janet Reno’s #2 priority” n “The government gets $23 for every $1.00 they spend in health investigations” n “The University of XXX just paid 7 bizillion dollars” n “Here’s a copy of the signature page of the University of Pittsburgh’s settlement”

9. #3 Promote Adam Smith’s Enlightened Self-Interest

10. Nirvana: They are convinced... n The program is theirs n The consequences are theirs n You’re there to assist and guide them

11. 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

12. #4 If it is clear they are dying… Be a hospice worker not a surgeon

13. #5 Park it in neutral

14. #6 Don’t just do something… stand there.

15. The Leader and the Lieutenants n Leader must be respected, have tenure, have power, and known to rarely use it n Lieutenants: clinically active, specialist champions, take some blame/heat, defenders of reason n Physicians respond better to other MD’s; better yet, of the same specialty

16. #7 Spot your 800lb gorillas early

17. #8 They gotta eat sometime

18. Thoughts on Effective Communication to Physicians n Prepare to listen n Defer impossible one-on-ones n Run short, organized meetings n Keep it pragmatic n Multiple small hits n Use humor, avoid sarcasm n Attracting agendas n Lunch, existing meetings

19. #9 Pick a style, any style

20. 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

21. Select a Style

22. #10 Take your own pulse

23. Physician Behavior n Expecting physician reaction is half the battle - forewarned is forearmed n Take you own pulse - never react back or you replace HCFA as the evil opponent

24. Difficult Physicians n Obstructionists –omission technique - go around not through n Antagonists –isolate –try to get to real issues –last resort - higher authority n Potential power > real power - use judiciously

25. #11 PEACO… but not a naïve one

26. 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.