Tuesday, October 9, 2012

Dial 911: Emergencies in Medical Writing (Open Session 21)


by Amy Karon

Nearly every seasoned medical writer can recall clients and contracts that evolved into the stuff of nightmares. Maybe endless requests for revisions are eating into your sleep time. Or perhaps you realize a high-profile faculty member is self-plagiarizing.

Stay in the profession long enough and scenarios like these are bound to make you hold your head at times. But there’s help. At the 2012 AMWA conference, Scott Kober, MBA, CCMEP,  and Anne Jacobson, MPH, CCMEP, reprised their popular open session on emergencies in medical writing.

Using digital keypads, attendees anonymously chose how they would handle a variety of problems. Lively discussion followed. Here we summarize those debates and dilemmas.

Scenario 1: Your work from long-term clients is drying up after more than 20 years of freelancing. Do you really need a web presence?

You do need a consistent and varied online presence, said Kober and Jacobson. But there are two ways to go about it—by dipping your toes, or going all out.

More cautious medical writers might start by creating their own simple website and LinkedIn profile. Others might hire a marketing and social media consultant to help develop a brand, website, detailed LinkedIn page, and professional Twitter account.

Whichever way you go, your website should include a resume and some sample writing or editing projects. If you’re under a nondisclosure agreement, keep that in mind. Some writers create pieces specifically for their online portfolios.

Scenario 2: Your last client burned you. How do you vet a new one to prevent this from happening again?

“My first-line approach is to e-mail people whom I trust,” Jacobson said. “Luckily, I know a lot of freelance medical writers whom I can vet clients through." She said she tends to avoid asking for feedback from members of AMWA's online discussion groups.

Kober and Jacobson also suggested crafting a checklist of the kinds of clients and projects you want. This will help you develop a broader perspective on whether prospective clients fit your business goals.

Scenario 3: You discover an author whose review article you’re editing is recycling chunks of text from a previous article. Whom do you tell, and how?

Make your client aware of this taboo practice and consider proposing a solution, said Jacobson and Kober. But don’t approach the faculty member yourself. Let the client handle it.

Be aware that copyright infractions can come back to haunt writers, they added. “Some faculty don’t even realize that self-plagiarism is a problem,” said Jacobson. “When this has happened to me, usually the remedy is just to rewrite (a piece) because it obviously can’t go out as it is.”

If a client tries to say self-plagiarizing is all right, rewrite the piece anyway and then don’t take any more work from the client, Kober said. Participants also suggested ensuring clients know that journals use software to detect plagiarism and copyright infringements and that such infractions can result in their being blacklisted.

As for red flags for plagiarism, watch out if a manuscript’s first draft is clean, with perfect punctuation, Kober said: “Plug it into Google and see what comes up.”

Scenario 4: You have a major deadline in three days and your father has been rushed to the emergency department. His physician thinks he’ll be okay, but has to run some more tests.

Do you go and bring your work? Tell your client you can’t make the deadline?

“Mild emergencies come up all the time and you find yourself schlepping your work all sorts of places,” said Jacobson. “The real question is whether to alert your client that there could be a problem. It depends on the client and the relationship.”

But from a client’s perspective, Kober said, “I would want to know as soon as possible. There is nothing worse than hearing on the day of the deadline, ‘Oh, I’m sorry, my dad has been in the hospital for a week and a half.’ I’m sympathetic, but I also wonder why you didn’t tell me before.”

Others recommended giving clients the names of three people they trust to get the work done.  Communication is critical, they agreed – let the hiring manager or the client know right away that you are working at a hospital. Most will appreciate the heads up and adjust their expectations accordingly.

Scenario 5: A client asks you to cover the cost of purchasing full-text references, which is not the norm. Do you renegotiate your contract?

Kober retrieves needed references for freelancers, but encourages them to get what they can on their own. “Ideally, from a client’s perspective, it would be great if we didn’t have to dig up references for you and find them.”

Said Jacobson, “When a client is nickel and diming you about project costs, they are unlikely to be willing to renegotiate a project fee.” She suggested searching on PubMed and restricting access to free, full-text articles. “Open access sources are now pretty good,” she added. “Every once in a while, I spring at the last minute for a $30 reference for a big project.”

Participants noted that AMWA membership includes access to MD Consult. Alumni organizations also sometimes offer limited journal access, and entering the full title of the article in quotes in online search engines also sometimes yields a PDF.

DeepDyve also offers lets you “rent” full-text articles for small amounts of money, members added, although you can’t print or save them to your computer.

Be careful about downloading PDFs and giving to clients, participants added; that can be seen as illegally selling them.

Scenario 6: A client is asking for many more revisions than expected. You are being paid for the extra time, but you’ve taken on other scheduled projects and this one is now keeping you up nights and weekends.

Think about how much you want to keep this client, Kober and Jacobson advised. If you don’t want to work with him or her again, consider politely extracting yourself by explaining that your contract does not include project management. You can also try to renegotiate for more money per hour.

Another approach: Say that you have taken on other projects because the plan did not include this much extra time.

Attendees also suggested building milestone payments into bigger projects so that at the end of 6 months, you’re not crossing your fingers hoping the client doesn’t refuse to pay (because you finally drew the line at further revisions) or goes bankrupt.

Scenario 7: You are writing multiple needs assessments for the same client on the same topic. Can you reuse your work?

“If you’re not willing to turn a blind eye to a faculty self-plagiarizing his own work, how are you willing to turn a blind eye to yourself?” Kober said.

Added Jacobson, “Once you have already done the mental work of understanding the same disease states, it is easier to crank it out. You do have an obligation to submit original material.”

But try for a bit of wiggle room when working with the same client on certain projects, Jacobson suggested. For example, agree to write updated needs assessments for the same client, rather than reinventing the wheel each time.

Scenario 8: After 5 years of full-time freelancing, you’ve decided to take a job. You just interviewed for what seemed like a terrific position, but half the interviewers did not show and no one explained why or followed up. Do you give the company the benefit of the doubt?

Jacobson said she is working on noticing red flags and steering clear of clients and companies who raise them.

“There are far too many employers who think they are doing an employee a favor by giving them the time to talk to them,” added Kober. “It’s a slap in the face. It’s rude and disrespectful.”

One option: Write a courteous letter to human resources explaining what happened and your disappointment. HR departments often appreciate hearing this, participants said. But don’t address your letter to the people who didn’t show up to the interview!

Scenario 9: You (in a client’s role) hire a freelance who checks out and has great references and clips, but turns in awful work. What do you say?

Attendees said they definitely want to hear feedback. Kober said he makes it a personal rule to give it. Jacobson recommends asking for an edited version of a document. If a client is constantly changing a certain word, for example, you can modify your writing style for that client accordingly.

When hiring and applying for work, require and send raw copy, suggested participant Debra Gordon. She added that she plans to send clients an anonymous SurveyMonkey questionnaire so they can provide honest feedback on her work without worrying about jeopardizing their business relationship.


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