Health system experts discuss how to amplify physicians' voices

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, Laura Fegraus, vice president, external affairs, communications & brand, The Permanente Federation, and Bill Melms, MD, chief medical officer, Marshfield Clinic, discuss their approaches to helping physicians amplify their voices during COVID-19 to engage with their patients, combat misinformation and share their experiences.

Learn more at the AMA COVID-19 resource center.

Speakers

• Laura Fegraus, vice president, external affairs, communications & brand, The Permanente Federation
• Bill Melms, MD, chief medical officer, Marshfield Clinic

Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we're discussing how health systems are helping physicians to amplify their voices during the pandemic. I'm joined today by Laura Fegraus, vice president of External Affairs, Communications and Brand for Permanente Federation in Oakland, California. And Dr. Bill Melms, chief medical officer at Marshfield Clinic in Marshfield, Wisconsin. I'm Todd Unger, AMA's chief experience officer in Chicago. Ms. Fegraus, let's start with you. Why is it so important that physicians are heard right now?

Fegraus: Yeah. Thank you for the question. And most of all, thank you so much for bringing us together today, to talk about this really important topic. At Kaiser Permanente, we're many organizations in one, we have hospitals; we have health plans, we also have the Permanente medical groups. And in those eight Permanente medical groups, they're organized under an umbrella organization called the Permanente Federation. And why this is important is because for a very long time, Kaiser Permanente has had a very bold social media presence and has been giving health care advice to folks and encouraging them to stay well and providing them with tools to manage their own health. But in the past few years, the Permanente medical groups under the umbrella of the Permanente Federation and individually have really started to mobilize the physician voice to talk about the virtues of Permanente medicine as a philosophy of care as being different from other types of care and in the pandemic have really found themselves to be a trusted voice.

Fegraus: And we know in communities, in society, that health care workers like doctors and nurses consistently pull better as sources of trustworthy information the public finds them to have high ethical standards. And in COVID-19 we sort of have two pandemics, right? We have the pandemic of the virus, but we also have the pandemic of fear. And that's really important to note, because the pandemic of fear can make the pandemic of the virus worse. And so what we really need is physicians to be using all the tools at their disposal to be clear, consistent, trusted sources of information for the public, so that they can keep themselves safe and protected from this pandemic.

Unger: Dr. Melms, we talked a little bit about your health system's approach to social media. Do you view it primarily as a platform to get your system's message out or do you support, or even encourage individuals to use it, to express their own views?

Dr. Melms: Well, I would say that our approach to social media has really shifted, the pandemic has been the cause of that shift. Pre-pandemic, our social media presence was one that included traditional advertising modality. It included trying to get just information about the services that we provide, any new services, for instance, but with the pandemic, we have become a voice of public health as our mandate. And I feel strongly about that, that's what we have done. That's what we continue to do as we work to battle misinformation.

Unger: So let's talk about how you balance the need to hear physician voices with your own health systems reputation. Do you view these as competing priorities or their shared priorities? And how do you work that?

Dr. Melms: Well, optimally, we certainly want them to be shared priorities. They are at times where they become perhaps, there's the possibility that they can compete a little bit. And we monitor our social media presence pretty carefully. We help our physicians; we coach our physicians in what they will present over social media, and we really need them to be consistent with the voice of the health system.

Unger: Ms. Fegraus, what do you think?

Fegraus: Yeah. I agree with everything Dr. Melms has said, and the other thing I would also add is that it's more important and most important for physicians to know how to engage safely. So how can you in representing yourself? And that's what we really ask the many of our 23,000 Permanente physicians that are online and have social accounts. Our policies say you're really representing yourself. And we ask all employees of the organization, the same to just put it on there, that you're representing yourself. At the same time, we are monitoring to make sure that physicians have the tools that they need to engage safely, the training that they need, helping them to navigate difficult situations, should they find themselves in one to de-escalate things.

Fegraus: And the other piece I would say is it's also an opportunity for organizations to have a bit of an early warning system about what's going on inside of their organizations. Are there problems that are being uncovered? Are there issues that staff are having that we can address? And a lot of times patients and members may get in touch with physicians online and say, "Can you help me with this?" Or, "I'm having a problem." Or, "Thank you for being so great with me when we saw each other last week." And I think those kind of situations require upfront training, good policies and also just constantly support and outreach to physicians to make sure that they can navigate and also responses from organizations. And this was particularly true in the pandemic in the early days, when we were hearing what was happening to folks at the front lines, I think it really helps focus the organization's attention on where we can be the most helpful and to support our staff and physicians.

Unger: I'm curious, do you see a tension between kind of the individual representing himself or herself and the reputation of the health system?

Fegraus: I think as Dr. Melms says, ideally you want those two things to be aligned and when the organization makes a statement about something that maybe could be perceived as political, it does give permission then for individual physicians to sort of carry that mantle as well. But I think at the end of the day, the most important thing is that you're offering physicians the way forward to navigate things when they are out there and just making sure there's an opportunity for them to get the support that they need. So in an ideal world, yes, they're perfectly aligned, but if they're not, social media is a fast moving thing. And as we know, lots of misinformation out there, so we want to just be as supportive as we can.

Unger: Dr. Melms, physicians are not only combating misinformation when they speak out, some are also sharing what it's like on the front lines and talking about issues like lack of PPE, capacity and how stressful the working conditions are, is your system supportive of physicians sharing these kind of frontline stories? Are their concerns with that?

Dr. Melms: We are supportive of that because we have nothing to hide. So if they are having difficulty in the front lines, we understand that the difficulties are because of the pandemic and we provide them all of the support that they need. Probably our best moment of social media was where we took two front line workers, we took two nurse managers from one of our COVID units, and we put them in front of a camera to speak to our system leaders to talk about their experiences. And these were difficult times. They were difficult things they were facing. We took that; we put it on social media, we had tens of thousands of hits and it ended up resulting in getting on some national evening news programs to get our word out. So it worked very well. It did exactly what we needed to do in terms of raising awareness for the public as to the importance of this and the seriousness of all of this.

Fegraus: Yeah. I'd add a couple things to that. I think as physicians and staff are using social media as a tool to sometimes work through what they've seen during the day, particularly in this pandemic time, which has been incredibly fraught for folks working in health care systems, we understand that and I also think that those are the moments that engender the most trust because they are physicians being real with the public about their own personal experiences. And I think moving forward, those are the moments where the public connects with them, sees them as human beings, learns to follow their advice even more because they're trusted, they're being vulnerable.

Fegraus: At the same time, as we said, we want to make sure our policies protecting, patient identifiable information, for example. So that's where you go back to helping physicians have the tools to do it safely. The other thing I would say is as the surge in the fall, really ramped up in many parts of the country, we used sort of front line views to help the public understand what was really happening inside of the health care system and how they can change their own behavior and support us in being able to care for them. So I think those very personal moments, while still behind a screen, they have the ability to move fast and to connect very broadly. And so we're in a new era of communication for sure.

Dr. Melms: Yeah. I agree with everything Laura just said, and especially the aspect of getting our physicians and other health care workers out there in front of the camera, in social media, because that does result in trust and developing trust.

Unger: I'm curious though, how does your system address, we'll call them sensitive issues, like politics or other things that might find their way into those kinds of conversations?

Dr. Melms: Well, we certainly avoid politics. If someone's representing themselves as a physician, they're welcome to do whatever they want to do. But from our system standpoint, I think the closest I got to a political statement was when I said that our leaders must lead and people could read into that, whatever they would like, but this has been a tough year for a pandemic, not that there'd ever be a good year, but having it being an election year when everything was politicized, when public health became a political volleyball, when it shouldn't have been, it was very unfortunate.

Unger: Yeah, a lot of sensitivities to be aware of. Ms. Fegraus, what do you think?

Fegraus: Yeah, I would echo what Dr. Melms said, and also just add that at Kaiser Permanente and in the Permanente medical groups, we really have public statements that speak more about values, a commitment to our mission, and do that sort of external communication around those things. It's a nonpartisan organization, our leaders are nonpartisan representatives at that organization. And when we do have physicians that are trained spokespeople or designated spokespeople for the organization, they are speaking on behalf of Kaiser Permanente at large and the Permanente medical groups. And we want to make sure that they have everything that they need to be able to do that without a partisan bed to it.

Fegraus: But I would echo what Dr. Melms said that this was a tough year. Public health was under attack. And there was a lot of opportunity for physicians to weigh in, I think in changing guidance, which also muddied the waters, right? You have the early months of the pandemic where we're focused on cleaning surfaces and fomite transmission and really downplaying masks. And then, all of a sudden we've got to switch to, well, it's maybe not as important to clean surfaces, but let everybody mask up. And so I can understand where a lot of the confusion persists and a lot of the opportunities for people to attribute partisan or political reasons for some of these things to change in guidance. And we just have to make sure that we're consistent in our values for sticking with our mission and only having people who are authorized spokespeople really be those people on behalf of the organization.

Unger: It's interesting because I've had conversations with other guests like Dr. Peter Hotez, I don't know if you're familiar with him, and other leaders that feels strongly that engaging with the public is very much a part of the physician's job and something they should be trained to do in medical school. And then, there are other systems that feel very differently about this. What are your thoughts on that?

Dr. Melms: Well, physicians certainly aren't trained to do it in medical school, I can tell you that. And what we find is that physicians self-select really, I mean, if we have a particular message that we need to get out and I need a particular specialty, we'll find somebody to do that, but generally they approach us because they're interested in it and we can provide the coaching that they want and that they need to be good spokesman for the organization.

Unger: Ms. Fegraus, how do you feel about that?

Fegraus: So my thinking is, and Kaiser Permanente just opened a medical school this year. My thinking, and this comes from anecdote experience living with an eight-year-old who's the IT tech support in my home. I'm not sure that anybody's going to have to be trained very soon because I think this generation of folks that are in their early twenties, mid-twenties attending medical school right now are probably way more sophisticated than the leadership themselves is about understanding social media and the platforms that are out there. So I think medical school should help emphasize the role that physicians have and social as one communication tool in addition to the in-person office visit and the telephone visit and all the other ways that they talk to their patients and their communities, this is just another tool. And I think they're going to be teaching us for many years to come.

Dr. Melms: I'll agree with Laura in that they certainly have an advantage in the tech over me, but some of the younger physicians don't necessarily have a good grasp on the gravity of what they say and the impacts of what they say. And that's probably where the learning needs to take place.

Fegraus: Yeah. So the responsibility of social media is very important.

Unger: Well, that's a good question then for our final one, which is, how will you continue to support your physicians speaking up, hopefully soon post pandemic, any thoughts on how you might change your approach down the road?

Dr. Melms: Well, we have learned during this pandemic, I believe this is underscore the absolute importance of the physician voice in all of this. So we will continue to develop this. I'm not looking for a paradigm shift probably, but we have learned a lot during the pandemic. We'll continue to develop the physicians voice, we'll continue to provide support and offer opportunities for coaching.

Fegraus: I would agree. I don't think there's a need for a paradigm shift either. I think we're just going to keep doubling down on our efforts to bring more physicians into the tent, to be able to help them engage safely, give them the tools that they need, provide the trainings and then be there to support them out there on the internet when they're engaging in social media activities.

Unger: That's really amazing. Thank you both for the work that you do to make sure physician voices are heard. That's it for today's COVID-19 update. I want to thank you Ms. Fegraus and Dr. Melms for being here today and sharing this important information, we'll be back soon with another COVID-19 update. For resources on COVID-19, go to ama-assn.org/covid-19. Thanks for joining us.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.