So You Want to Write A Book (Open Session 1)

By Amy Karon

At AMWA's recent national conference, attendees chuckled and scribbled notes while authors and former journalists Alisa Bowman and Debra Gordon dispelled myths and offered practical tips on breaking into the book business.

The two know the market. Bowman spent several years as an editor at Runner’s World magazine before her husband negotiated her first book contract during a magazine gala at FAO Schwartz.

“I loved my job at Runners World,” said Bowman, who has since ghostwritten* and co-authored seven New York Times bestsellers. “But it was apparent to me that I could make much more money working for myself.”

Gordon’s titles include When Sex Hurts and The Idiot’s Guide to Type 2 Diabetes, and, with her husband, a fellow enthusiast, Wine on Tuesdays. “We managed to do it with our marriage intact,” she grinned.

Read on for Bowman and Gordon’s advice on taking nonfiction health and medical books from inspiration to publication.

Tip: Books published under your own name often pay little. 

In traditional publishing, Gordon said, authors receive only about 15 percent of book sales, and that first goes to repay the publishing company’s advance. “The vast majority of authors never receive royalties,” she added. “Write a book because you want the experience and exposure.”

But self-publishing and e-books have gained popularity as potentially lucrative alternatives. Authors pay a self-publishing company for services they choose, such as copy editing and printing, Bowman said. Because no agent or publisher are involved, the author earns 100 percent of the sale price of every book and can still sell it on Amazon.com.

Another way to make money by writing books is to ghostwrite or co-author with someone else, an accepted practice in the publishing world.

“Most of the bestsellers out there are written by people like Alisa and me,” said Gordon, adding that she just signed a $70,000 contract for a book on mobile health.

To break in, tell clinicians and academics you can help them write books for consumer audiences. If you see a study you think can make a book, contact the authors and pitch the idea.

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.

Who Knew Theory Was So Popular?

by Lori Alexander

In an organization as practice-oriented as AMWA, the audience at Thursday morning’s “Using Composition and Persuasion Theories to Improve Your Medical Writing” was extraordinary. Panelists Tom Lang, Helen Hodgson, and Dan Jones had estimated that the topic would draw about 50 attendees, especially considering the always-strong competition among open sessions. All of us were pleasantly surprised to see a standing room–only crowd fill the enormous room!

Tom discussed the evidence base for writing, highlighting the importance of two documents: Document Design: A Review of the Relevant Research and Guidelines for Document Designers. Tom provided an overview of the importance of language usage and framing, a practice that he referred to as the “real ethics problem” for medical writers (above authorship issues, even!). He described framing as a form of cognitive bias in which the context organizes perception. As a classic example of framing, he noted that people are more likely to choose a procedure that has a survival rate of 85% than one that has a fatality rate of 15%.

Helen summarized several composition theories, noting how medical writers can use the theories to evaluate their own work. For example, in critical/cultural studies, researchers examine systemic and cultural injustices inflicted by dominant social groups on those with less power (race, class, gender, sexual orientation, etc) and read texts carefully to determine how language and structure reinforce the power dynamics. “As medical writers, you need to be aware of these issues, and modify writing to redress the power imbalance and reflect understanding of the discourse community,” she said.

Rounding out the session was Dan Jones’ discussion of contemporary persuasion strategies that medical writers can use to reach consensus in the workplace. Dan focused on the science of persuasion—specific strategies that have been scientifically proven to be effective. Among the most widely used are six weapons or principles of influence described by Robert Cialdini: reciprocity, commitment and consistency, social proof, liking, authority, and scarcity. Dan encouraged attendees to think about how to put these principles into action not only in their writing but in their workplace relationships.

2011 AMWA Salary Survey (Open Session 6)

by Karamarie Fecho

If there’s one thing that all medical writers have in common, it’s the need to earn a living. We may be passionate about our writing, but passion doesn’t pay the bills. The much-anticipated results of the 2011 AMWA Salary Survey were released Thursday afternoon during a presentation by Susan Bairnsfather at the annual AMWA meeting.

After listening to the presentation, I have to say that, quite frankly, AMWA’s members appear to be weathering the economic downturn very well and, dare I say, even thriving. Both traditional business employees and freelancers, part-time and full-time, showed an increase in their annual income from 2007 (the last year the salary survey was administered) to 2011. The increase in employee income was ahead of the inflation rate—12.9% vs. 1.3%.

While US government–reported inflation rates are admittedly low and do not reflect true purchasing power (a point raised by a participant at the presentation), the reported increase in salary was large enough that one could infer that, at the very least, medical writers are faring well in these tough economic times. Interestingly, however, the feeling among many who listened to the presentation was one of caution regarding interpretation of the survey results. Several people pointed out that the survey response rate was down by 10% and that the survey itself did not “capture” unemployed (or even underemployed) medical writers.

Whether these concerns are warranted or the result of an internalization of the economic situation is unclear. It is true, however, that the survey, like most surveys, had limitations, including the low response rate and a lack of survey participation by employees whose employers (primarily pharmaceutical companies) prohibited them from responding to the survey. Regardless of these (admittedly valid) concerns, this presentation left me feeling a renewed sense of validation for my profession and my profession’s economic worth.

Good Publications Practice 2 and You (Open Session 36)

by Heather Haley

Navigating the current medical publishing environment is challenging, whether it’s figuring out which of the many CONSORT statement extensions applies to your project or collecting all the conflict of interest disclosures from ten authors in four countries. However, success starts with knowing Good Publication Practice 2. Published in October 2009 in the British Medical Journal, Good Publication Practice 2 (GPP2) captures the best current standards for communicating medical research sponsored by companies.  (For a copy of GPP2, visit the Web site http://www.gpp-guidelines.org, where you can also watch a webcast about it.)

Covered in the AMWA 2010 conference open session, Navigating the Current Medical Publications Environment, key GPP2 recommendations include:

• Written agreements between the company and academic-physician authors.
  • These author agreements can address a host of issues from access to data, author obligations to disclose conflicts of interest, author responsibilities for timely publications. The GPP2 paper has a great checklist of what to include in an author’s agreement.
• Contributorship model for the acknowledgements section for people who do not meet the ICJME authorship criteria as well as the role of the sponsoring company in funding and executing of research.
• Suggested language for contributorship is: “The authors would like to thank D, YZ Pharmaceuticals, for overall management of the trial and E, WX Medical Writing, for drafting the manuscript.”
• The role of the sponsor in the medical research needs to be detailed. Suggested template language that can be adapted to each situation is: “In collaboration with A and B, YZ Pharmaceuticals, designed the study, analysed, and interpreted the data, and edited the report. Data were recorded at participating clinical centres and maintained by YZ Pharmaceuticals. All authors had full access to the data." If journal submission requirements do not accommodate this information, then put it in the cover letter accompanying the submission.
• Creating publication steering committees to identify and oversee the communication of research results in presentations and journal publications.
• Visit the GPP2 website for ideas on who belongs on publication steering committees.

The key theme for GPP2 is transparency. In this current environment of controversy, more disclosure is the rule of thumb when in doubt. The GPP2 authors recommend going above and beyond disclosing conflicts of interest and medical writing support on posters as well as publications. Since no one becomes a Wall Street Journal story for disclosing conflicts of interest.

A highlight for GPP2 is that the update was a more collaborative process seeking input from all the key stakeholders. 116 individuals representing academic centers, journal editors and publishers, medical communication agencies, freelance medical writers, pharmaceutical, medical device, biotechnology, and professional organizations provided comment on the first draft of GPP2.

The Navigating Medical Publications talk was attended by about 30 people, and honestly I was surprised by the number of people who didn’t know the GPP2 update had come out. New publishing or research reporting guidelines can be found at the Equator network. Read Good Publications Practice 2, for yourself. It’s definitely a must if you are taking the Certified Medical Publication Professional exam (CMPP). But also, pass along some of the useful checklists or template language to your colleagues or clients to help make navigating the current medical publishing environment a little easier for everyone.

Defining and Refining Medical Communication: Competencies, Research, and Theories (Open Session 16)

by Mary Wessling

At Open Session 16 of the annual conference, panel members approached the issue of how to discover the appropriate measurements, and how to construct a program using AMWA resources, that enhance the competency of our members as medical communicators.

David Chernow, a scientific communications consultant for Eli Lilly and Company, described the Medical Writer Competency Model developed by the core team members of the Drug Information Association Medical Writing Special Interest Area Community. This model (I'll call it the DIA model for convenience) was developed by a team of experts from around the world who employ medical writers or who use medical writers as part of their jobs. Overall, the model looked at the knowledge, skills, and behavior that are intrinsic to success as a medical writer, and then in particular, what different categories of jobs in medical writing would demand. The core competency, they agreed, is the ability to tell a scientific story. The model could be used by an individual to assess his or her abilities to enter the field, and also by employers to judge the suitability of applicants for a job they need to fill. It can also be used to train present employees for transitions to other jobs within the organization. David stressed that the model has its limitations, and among them, that it does not prioritize the skills in assessing competency.

Marketing Your Career by Being Proactive (Open Session 26)

by Sarah Thornburg

You probably know that reaching out to your network in times of need can lead to enormous support. But you may not always remember that if you do not take the time to build your network when times are good, you may be missing out on many opportunities.

In today’s job market, you can never predict what is around the corner. And, in a field that is constantly evolving, you are responsible for identifying your skill sets and matching them to the projects that are the best fit for you. In this open session, moderator Noelle H. Demas and panelists Lisa Balbes and Alison Greenwood provided useful strategies for increasing your visibility and maximizing job searches.

Evaluate your skills and identify your short-term and long-term goals. You might find that you aren’t pursuing the type of work you most enjoy. Also, consider whether what you do today is your ideal job or a position that will help you to transition into your ideal job.

Networking helps you to let people in your life know the type of work you do, and is one way to expand the circle of people who know it. You can network by attending professional meetings, volunteering, or using social networking sites like LinkedIn, Facebook, and Twitter. Even if your goal is not to make a change or to gain information, sharing your wealth of experience will help strengthen the medical writing community. And, who knows, it might present you with an opportunity you didn’t even know you wanted!

You can simplify how you manage your career development by making a list of the types of projects you’ve worked on and keeping an active experience summary. This list will help you see where you are in your career and think about where you want to go next. You can also create a concrete growth plan to track goals in categories like “increase skills and knowledge,” “gain credentials,” and “increase your value.”

Electronic resources can help you create a list of interesting companies during a job search or goal setting. Resources like BioSpace, Monster, and Indeed, and databases like ReferenceUSA, Sorkins, and Standard & Poor’s can connect you with information about employers, where they are located, and who their competitors are.

Keep your ear to the ground about the trends in the market by looking for keywords in job ads, reading the publications your customers read, talking to people in your industry, and tracking your company, industry, and market. Just by skimming job ads, and reading headlines in magazines and journals, you’ll gain insight into opportunities that others might not notice.

The bottom line of this presentation was that by evaluating your skills and goals, being aware of trends in your field, and maintaining a vibrant professional network, you can maximize your relationships and leverage your skills so you can recognize and respond to exciting opportunities.

Adult Learning Styles (Open Session 28)

by Kelly L. McCoy

Chances are that if you are a medical writer, educating adults is something you do, or try to do, fairly regularly. Think about it: Whether you are writing a CME program for a physician audience or a sales training module for a pharmaceutical company, your writing serves as an educational tool for the audience you are targeting.

Speaking about this topic—adult learning—at the national conference were two Northwestern Mutual employees, Paula Brzezinski, MEd and Peter Dickert, who were led by an AMWA-member moderator and former colleague of theirs, Lisa Wytrykus Kleppek.  The speakers admitted that it is not always possible to incorporate every learning style (e.g., auditory, visual, and tactile) in every type of training. What you can do is make the best use of the style that you are using. In doing so, they suggest that you take 7 important principles into consideration when developing educational content:

• Relevance: Why are you educating the adult about this topic?

• Responsibility: The adult learners should be responsible for their own learning decisions.

• Life experiences: Build on what learners know and give them credit for what they know.

• Timeliness: Provide training at a time that is relevant to the learner.

• Engaging/applicability: Make learning relevant and allow for learner participation.

• Respectful environment: Encouragement, positivity, and being patient may go a long way in gaining an adult learner’s interest.

• Motivation: Understand what will motivate a learner to learn.

With these principles in mind, you will come to understand the rationale behind the training pieces you write, the goals of the program, and importantly, your audience, which will provide context for your content, which may be an important component of adult learning.

Key Findings From the AMWA-CMR Research Project (Open Session 11 and Poster)

by Sue Hudson

How are medical communication departments organized in major pharmaceutical companies? How is the productivity of writers and editors measured? What impact does outsourcing have on document quality or on productivity?  In an open session and poster presentation at this year's conference, results of a landmark 2009 survey conducted by AMWA and CMR International were reviewed.

Key findings:
1. Regulatory departments in most companies who responded to the survey outsource many document types, but not Phase 1, 2, and 3 clinical study reports.
2. The fact that 100% of respondents’ companies outsource the development of protocols for clinical studies was a surprise to the audience in the AMWA open session; discussion centered around the critical nature of these publications to any clinical study. (Maybe future research could find out why they’re outsourced.)
3. About half of manuscript writing is outsourced by big pharmaceutical and biotech companies that responded to the survey (good news for freelances and agencies).
4. Only 2.5% of respondents used out-of-country vendors (defined as vendors outside the country of the company doing the work; for example, for a company in Germany, sending a project to the U.S. would be out-of-country).
5. Document quality and lack of face-to-face communication were cited as obstacles to out-of-country outsourcing.
6. Resource constraints are the most common reason for the outsourcing of documents. Good experience with vendors, specialized vendor expertise, and cost were also noted.
7.   Managers in 57% of companies said the quality of work done by in-house staff was better than that of vendors.
8. Managers in 62% of companies said there was no difference between the productivity of in-house staff and outside vendors; when a difference was seen, in-house staff was more productive…. BUT
9. Documents developed by outside vendors took longer to produce than those developed by in-house staff.

(And 10. Research is hard work and takes a long time.)

Regulating Health and Medical Information on the Internet (Open Session 24)

by Alisa Bonsignore

As medical writers, we have a good idea of how to separate truth from fiction when it comes to health information on the Internet. Unfortunately, the average consumer does not.

An increasing number of unskilled caregivers – ordinary people caring for their sick spouses or elderly parents – are looking for information about medical conditions, treatments, side effects and alternative therapies. In many cases, the information that they’re finding is not coming from knowledgeable sources, but rather from blogs and Wikipedia articles. Efforts are needed to ensure quality and confidentiality while protecting against fraud and misleading advice.

Established in 1996, the Health on the Net Foundation (HON) is a not-for-profit organization that points health seekers in the right direction.

“HON guides Internet users by highlighting reliable, comprehensible, relevant and trustworthy sources of online health and medical information, tackling the major obstacles of the Web:

• The overwhelming quantity of information

• The uneven quality of health information online”

Health-related Web sites can request a free evaluation for certification and are inspected by the HONcode committee based on a set of 8 guiding principles. A web site must be evaluated annually and is granted the HONcode seal as a trusted information source.

To date, more than 10 million Web pages have been certified in 102 countries and 35 languages. HONcode certified sites are more consistently found to have better and more reliable information than you would find through a common Google search.

For more information about HON and its mission, visit http://www.healthonnet.org.

It's All About Style

by Sue Hudson, Open Session 4 Moderator

You know you’re a medical writer when. . .

. . .you were one of about 200 writers and editors who packed a meeting room at the Milwaukee Convention Center Thursday morning to hear Cheryl Iverson and Devora Krischer talk about the AMA and CSE Style guides. (The speaker for the APA style guide was unable to join us.)

In response to Cheryl’s question, almost everyone said they use the print version of the AMA Manual of  Style, and many use the online version. But only one person raised her hand when she asked who had used the latest feature of the online site, My Style, which allows a user to save up to 15 searches and bookmark or annotate specific items. Cheryl , who led team of writers and editors who created the AMA guide, highlighted other useful features of the online guide, including:

• the ability to copy and paste passages into a document, so you can show your author why you dared to edit his or her perfect prose

• an electronic SI unit converter

• quizzes on matters of style, which can help to prepare for the BELS exam or be used (with permission) for your own training classes

• editor’s tips such as cures for “link rot” or how to write good titles for an article

Devora noted that the CSE style guide (Scientific Style and Formatting, 7th edition) goes beyond the medical and biological sciences, providing resources for scientists from geology to astronomy. With the lines blurring between genetics, chemistry, and biology, this resource is important for editors who need a broad background. Devora noted that the CSE guide contains information for writers and editors working on pieces designed for publication in European journals, including tips for converting between English and American spelling and usage. Work is beginning on a new edition of the CSE guide.

Audience members peppered the panel with questions, including how to choose a style guide when the target journal is unknown. The answer? Comply with the uniform requirement of the International Committee of Medical Journal Editors (ICMJE). After that, it’s easy to tweak a manuscript for a specific publication and its style requirements, Cheryl and Devora agreed.

Related Links
AMWA home page for link to AMWA members-only discounts for AMA Manual of Style (hard copy and online versions)
Council of Science Editors information page on CSE Manual for Authors, Editors, and Publishers

Meeting the Needs of Tomorrow’s Medical Writers: AMWA’s Expanded Professional Education Program

by Victoria White

A shorthand way of describing members of AMWA is to say that we are either writers learning to become scientists or scientists learning to become writers. That is a great description, as far as it goes, but if you are involved in designing a professional education program to meet AMWA members needs, it doesn’t take long for things to become much more complicated.

Where are you in your career? Who is your audience? What is your therapeutic area (to use that two-word combo that seems so common at these meetings)? What skills are you lacking? Are you familiar with current ethical standards? And stats, what about stats?

AMWA’s workshop-based education program debuted in 1979. In the past year, AMWA has unveiled an updated program that is designed to offer a wide range of workshop options in key areas of interest to medical communicators. For existing members, there is a new lingo to learn. For new members, well, they also have a lingo to learn.

In Open Session 3, moderated by Douglas Haneline, panelists Lawrence Liberti, Susan Aiello, and Dane Russo explained the new system.

In a nutshell: Members who have been working on core, science fundamentals, and advanced certificates under the old system can generally continue to do so. New members should look to the updated curriculum.

In the new system, the Essential Skills curriculum will be the place to start. Essential Skills courses will provide a basic grounding in editing, writing, communication, and bibliographic skills. An ethics workshop, which is being taught for the first time at this year’s conference and will be available toward the end of 2011 in the distance-learning format, is required for earning a certificate.

Success Stories in Health Literacy (Open Session 35)

Why do we have to struggle to further health literacy, when the future of health care seems such an important issue today? Why don’t people just embrace it? Those were the questions that panel member Delores Isham-Colvard, PhD, RN posed in the first presentation of this open session. Jane Krauhs, PhD, moderated the panel of three persons who shared their success stories; in them we find tools for improving our own efforts.

Isham-Colvard, manager of Patient Communication at Children’s Hospital, Dallas, noted that the costs of failing to promote health literacy are high, with communication failures at the root of so many problems, including legal liability, in health care. As far as getting others involved in health literacy, first, she says, “put your face out there.” Get on committees. Here, she told her own “Saga of Pee and Poop” and her experience with her hospital administration who strongly preferred using “urination” or “making water” in brochures. Using words that patients, and especially children, understand is not dumbing down. Writing at the literacy level of most Americans—the 5th or 6th grade level—only makes sense. We should write for our audience.

Shirin Pestonjee, MS, RN, reinforced Isham-Colvard's point. Pestonjee is a patient education specialist at Parkland Health & Hospital System in Dallas. Surveys taken in 1988 and 1998 attest to the success of the Parkland program, which begins with an orientation of new employees. She points out from the very beginning, employees are encouraged to use words that patients understand, like… “pee in the cup,” not “void in the cup.” Many health professionals want to talk at higher reading levels; they are either unaware and can’t grasp the scope of levels, or fear that patients will feel “talked down to.” She gave the example of a fancy packaged system of health information that the employees, after they came to an understanding of literacy levels, rejected—because the reading was at a 12th grade level.

Getting your manuscript published (Open Session 28)

This was a great panel discussion about the details that give your manuscripts an edge in the eyes of the reviewers or editors. Marianne Mallia served as moderator. Her panelists were an author’s editor and journal editor in-chief.

Christine Wogan, MS, ELS, the author’s editor, from the UT M.D. Anderson Cancer Center, phrased her take-home messages for other author’s editors clearly:

• Pick your battles.
• Hook 'em.
• Give 'em what they want.
• Make it easy on them.

She provided a variety of tips for assisting authors. Read the paper thoroughly for spelling, punctuation, and grammar. Make sure that the paper is written at the proper level of understanding. By targeting the paper to a specific journal and following the instructions to authors, the manuscript’s chances for acceptance improves. She emphasized that manuscripts must tell a story in a linear fashion. She suggested writing the abstract first – but editing it last.

Palliative Care: Collaborative Communication at the Edge of Life

This open session, moderated by Tamara Ball, MD, with panel members Lee Hancock of the Dallas Morning news and Robert L. Fine, MD, director of the Office of Clinical Ethics and Palliative Care at the Baylor Health Care System, Dallas, was one of the most moving and inspiring one and one-half hours I’ve ever spent, and that is no exaggeration. The mood was set by a video, made by Dallas Morning News photographer Sonya Hebert, of the last days of patients and their loved ones. The basis for the session was the history of collaboration between the reporter, the photographer, the palliative care physician, and the palliative care nurse Min Patel that became a Pulitzer-nominated 5-part series in the Morning News.

Dr. Fine set the history of his 2004 initiation of palliative care at Baylor in the broader context of the clinical ethics movement that came to the fore after the famous 1970s court battle over removing Karen Ann Quinlan from a respirator; by the early 1990s, he and his colleagues were doing over 100 ethics consults per year. Dr. Fine’s inspiration initially came from members of the clergy-in-training program at Baylor who spent time with the dying persons, helping them and their loved ones with the nonphysical pain that accompanies the end of life. Looking at the number of deaths in his hospital, Dr. Fine saw the need for healthcare workers to provide something beyond quick visits to lessen physical pain. He asked himself how his big-city hospital that has many patients awaiting organ transplants and serves a large indigent population could ever afford a palliative care program. The answer came in the way of an anonymous donor who wrote an $80,000 check to get the program started.

In 2007, Dr. Fine got a call from reporter Lee Hancock in which she proposed a story on the Baylor palliative care program. He described his reaction: “I don’t think so!” Turns out Lee had recently written a story that was less-than-favorable about Baylor. But then he realized that “getting the story out” might be a way to raise money for the program. His team also had some initial hesitancy but then agreed.

A meeting with Lee helped convince Dr. Fine to go forward. She had first-hand experience with the anguish that a family feels watching a loved one suffer: Her youngest brother had developed a mysterious fungal infection in his brain, and after 5 years in and out of the hospital, spent 8 months of his last year of life in the ICU. On her visits, she saw not only how her family struggled with what was happening, but also the nurses’ anguish over their inability to help. Back in Dallas, upon hearing her interest in improving the situation for end-of-life care, people kept pointing her to Dr. Fine.

No Medical Degree? No Problem!

I admit it. This year I needed a pep talk. More and more, it seems, job ads for medical writers -- even ads seeking freelance help -- state that a science degree is required. Some even specify an MD or PharmD or PhD. I almost always have as much freelance work as I want, but still, I worry. Is this the way the medical writing world is going? I am only 49; even if I retire as scheduled, I have 21 years to go. Is the day coming when excellent writing skills won't be enough?

In his free open session on how nonscientists can succeed in medical writing, Scott Kober helped allay my fears. The session was geared toward people wanting to break into our field, but it reminded me of why we liberal arts majors are special. Scott discussed the advantages of a humanities background and explained what skills nonscientists can highlight to differentiate themselves in the marketplace. I especially enjoyed the "case studies" that showed how real people --journalists, technical writers, even a Russian studies major -- fell into medical writing. Scott also candidly described the limitations of a liberal arts background and the self-education that's needed to augment it.

Most useful to me was this quote from one of the women featured in a case study: "I don't bother responding to ads that say 'MD or PhD required.' That tells me that the hiring party doesn't really understand the skills that are necessary for medical writing." Oh, bless you, anonymous colleague! My attitude has been adjusted and I'm good for another year.

--Faith Reidenbach

Bubble Boys (and Girls)

I am half of a 2-person company, so I work practically alone, and for me that's both the greatest and worst aspects of being an independent writer. I am far more productive than I could otherwise be, because I'm free from corporate meetings and colleagues' interruptions. But I don't have a boss or many colleagues, so hardly anyone ever challenges my decisions, and my ego isn't always right-sized. A related problem, and even more dangerous, is that my insular existence threatens to keep me from hearing the latest thinking in our industry.

Open Session 10, "Navigating Today's CME Landscape," was a good example to me of why I benefit from attending the AMWA national conference. I write a regular column on trends in medical communications ("Briefly Noted," published in the AMWA Journal), and I've followed the sea changes in CME closely -- or so I thought. But Mary King and Johanna Lackner-Marx had much to teach me about the newer CME accreditation process and how adult learning theory has influenced what accrediting bodies expect from CME providers. Tara Hun-Dorris wrapped up the session with exceedingly practical tips for writing CME materials (and for dealing with difficult faculty), and she gave me a kick in the pants about moving beyond print media.

One of the highlights for me of this year's conference was a workshop that went beyond the lecture/discussion format. I would urge more AMWA workshop leaders to create activities for attendees who are principally auditory or kinesthetic learners. Probably this is too easy for me to say, as I've never led a workshop, and honestly, I mean no disrespect to the VOLUNTEER leaders. In a workshop I attended yesterday, "Audience Analysis for Health Care Communication," led by Bob Bonk, the small-group exercise was very valuable. My team of 5 women, from very different backgrounds, had to outline 2 documents on the same topic for different audiences. There was initial tension and disagreement, and we never did reach true consensus or, perhaps, draft the best possible outlines. But by gum, we got the job done on deadline! The exercise reminded me that even when I'm snug at home, I am part of a team, and I forget that at my peril.

--Faith Reidenbach

The Freelance Biz

According to his disclosure statement, Brian Bass is not an attorney, accountant, or insurance professional. But Friday, he educated a lively audience about the many legal, financial, and insurance issues that affect freelancers during his open session, “Getting Down to Business: Nonwriting Issues for Freelances.”

By flagging the parts of contracts that freelancers should watch out for (i.e., non-compete agreements and transfers of liability), Bass provided his audience with some of the necessary tools to master contract negotiations. Rather than striking out part of a contract and initialing it, try calling the client to see why this particular clause was included in the first place, he suggested. Having a discussion about the contract may trigger your client to think twice about the reason for including such statements.

Creating a business structure is another important issue for freelancers to consider—particularly relatively new writers. Following a broad overview of the pros and cons of sole proprietorships, S-Corps, and LLCs, an impromptu, mid-session Q & A period took place. Bass (with the assistance of knowledgeable audience members) entertained questions about paying yourself on a consistent basis, separating your business and personal assets, and for those with S-Corps, paying bonuses on December 31st.

To wrap up the session, the nuances of health insurance, life insurance, long-term disability insurance, and errors & omissions insurance were discussed. Ultimately, obtaining these various insurance policies affords protection for you, your business, and your family, Bass emphasized.

This session will be covered in more detail in a forthcoming issue of the AMWA Journal

--Kelly L. McCoy