When communicating with members of Congress or other lawmakers, the goal is to present the best argument in favor of your position and to respectfully ask that they consider it.
The AMA has produced a new resource, “Congressional Check-Up: A Guide to Physician Advocacy,” that recommends seven ways to effectively communicate with lawmakers. It does caution, however, that “it may take time and patience to achieve meaningful results.”
Given that reality, it is wise to connect early in the legislative process and to build an established rapport with senators, representatives and their staffs in order to have an influence as ideas are turned into laws.
Here are seven ways to effectively do this.
Understand the legislative process. This may not be as obvious as it sounds.
Colorado state Sen. Irene Aguilar, MD—who was a 2015 recipient of the AMA’s Nathan Davis Award for Outstanding Government Service—notes that people have lobbied her on federal bills she has no control over.
Dr. Aguilar, the former chair of the Colorado Senate Health and Human Services Committee, described how the differences between politics and medicine were a “culture change” for her.
“In medicine, especially internal medicine, I want to tell you everything I know because it may trigger a thought that helps with the diagnosis,” she said. “But in politics, you’re playing poker and you hold things back. It does take learning a new paradigm.”
Rob Jordan, AMA political and legislative grassroots director, said physician advocacy requires a different kind of thinking than what many physicians are used to.
“It’s a bit of a disconnect for a scientific mind,” Jordan said. “They think ‘This is the right thing to do, so why don’t you just do it?’”
Jordan said physicians have to learn how to explain to politicians that what they’re asking for is good for their constituents and therefore the right thing to do because it is in their best interest to do it.
Nathan Schlicher, MD, a former Washington state senator, agreed.
“This is not an academic exercise in evidence-based legislation,” said Dr. Schlicher, the second vice president of the Washington State Medical Association. “There are emotions involved.”
He noted that some exasperated colleagues complain, “That makes no sense!” when they learn of a bad political outcome and he replies, “Welcome to politics.”
Identify one or two topics of interest. If you are looking to discuss your ideas about expanding access to health care, don’t get sidetracked with a conversation about taxes, according to the AMA guide.
Use your personal stories. “We try to find the patient perspective in the story whenever we can,” Jordan said. “For a lawmaker, it makes the decision more meaningful. Let them know something is not just affecting physicians—which is just one stripe of the lawmaker’s constituency—but it’s affecting patients, which covers all their constituencies.”
Connect potential impacts to people. Dr. Schlicher said stories are what lawmakers will remember about a visit. “I tell them about people sitting in the ER because there are no psych beds,” Dr. Schlicher said. “I think the stories are what makes or breaks it—and they should always be HIPAA compliant.”
Be respectful and honest. The guide suggests putting yourself in the shoes of the lawmaker and asks how would you prefer to interact with someone who wants to convince you to see something from their perspective?
Henry Dorkin, MD, president of the Massachusetts Medical Society (MMS), explained how this is done.
“We never start by saying: ‘We have a problem with what you’re doing on X, Y and Z,’” he said. “Instead, start with: ‘We want to thank you with what you’re doing with A, B and C,’ and then you mention your concerns with X, Y and Z. Never start with a negative or it’s just going downhill from there.”
Dr. Dorkin added that advocates should also inform legislators how a bill will have impacts they care about.
“Show them that it helps patients and lower costs—if you tell them something is revenue neutral, they’ll listen,” Dr. Dorkin said. “But, if you tell them something will save money, you have to show them how it will.”
Focus on the specific legislative issues. Don’t make threats of retaliation or quid pro quo promises because they are counterproductive to the goals of communicating with Congress, and will make building a relationship an uphill battle, the AMA guide states.
“We try to reinforce with grassroots advocates and state medical societies that, in politics, you don’t have permanent friends and permanent enemies,” said Jordan. “Legislators are voting on issues not because you’re their friend or they like you, but because they think it’s the best thing to do.”
Offer your expertise. Providing information and feedback on ideas and health care issues that matter to your senator or representative helps build a lasting two-way relationship, the AMA guide suggests, noting that this contrasts with always asking for something.
“Our expertise is taken seriously,” said MMS past President Dennis Dimitri, MD, recalling how physicians met with legislative staff tasked with implementing Massachusetts health system reform. “Much to my surprise, much of what we talked about appeared verbatim in the legislation.”