Patient education content for MD2P.net

As a freelance  writer, I researched and wrote patient-facing medical education content for niche publisher MD2P.net.

The company produced Patient Education Content Gary Bridgmanbooklets and web content about various medical subjects and custom branded them for individual clinics to distribute to their patients.

My delivered manuscripts covered the following cardiology topics:

  • Congestive heart failure
  • Coronary artery disease
  • Myocardial infarction
  • Women and heart disease​ (text below)
  • Atherosclerosis
  • Bypass surgery
  • Valvular disease
  • Valve replacement/repair surgery

Heart disease is different for women

Women’s and Men’s hearts work the same way, but they seem to fail differently.

The silent majority
Coronary heart disease has often been perceived as a “man’s problem,” and that women are more likely to succumb to breast cancer. But in the U.S. alone, 42 million women live with cardiovascular disease (remember that strokes are part of this problem). In fact, cardiovascular disease kills almost twice as many women as all forms of cancer combined.

Less dramatic heart attacks
While chest pain (angina) is the most common symptom of heart attack (myocardial infarction) for both men and women, it is not a reliable indicator for women for two very different reasons:

  • Women are not as likely to experience chest pain before or during a heart attack.
  • Women who do experience chest pain may not be having a heart attack at all, even if they have already been diagnosed with heart disease. Women tend to describe their chest pain more as tightness, pressure or an ache.

Earlier warnings, often ignored
Women experience more pre-symptoms (prodromal) before an actual heart attack, granting precious extra time to seek medical attention. A clinical study by the National Institutes of Health observed this “early warning” trend in 95 percent of female heart-attack victims who were observed. Unfortunately, when a heart attack actually strikes, women are more likely to delay seeking emergency treatment—often resulting in permanent heart damage or death—because they think their symptoms are a false alarm.

Women develop coronary artery disease later in life
Men typically have a 10-year “head start” on developing heart disease. Women with active ovaries and normal estrogen production seem to be protected against hardening of the arteries (atherosclerosis), a primary cause of heart attacks, until after menopause. The percentages of men and women with heart disease equalizes by age 70, but women in that age range may have other medical conditions or complications that can limit more aggressive treatments.

Less medical knowledge about women with heart disease
Historically, only 27 percent of participants in all heart- and stroke-related research studies have been women. For decades, most research subjects were middle-aged, white men. As a result, symptoms of a heart attack are still divided into two lists: “typical” and “atypical.” A man who only has a couple of “atypical” symptoms is not in serious trouble. But the most common symptoms for women are often found down in that “atypical” list. To add to the difficulty in diagnosis, these “women’s symptoms” are easy to confuse with many other, non-coronary conditions.

The lack of understanding about this disease seems to go both ways
The American Heart Association reports that only 55 percent of women realize heart disease is their No. 1 killer and less than half know what are considered healthy levels for cardiovascular risk factors like blood pressure and cholesterol.

Heart disease risk factors that affect women more

  • Cigarette smoking (stop!)
  • Depression and/or mental stress.
  • Reaching menopause (but estrogen replacement therapy may raise the risk further)
  • Metabolic syndrome:
  • High levels of LDL or “bad” cholesterol
  • High blood pressure (hypertension)
  • High blood sugar (hyperglycemia, usually via diabetes)
  • Obesity (specifically around the waistline)

General risk factors

  • High intake of fatty foods (eat less saturated fat, cholesterol and salt)
  • Family history of heart disease
  • Lack of physical exercise or labor
  • Heavy alcohol consumption
  • Age (65 for women, 60 for men)

Heart attack symptoms and pre-symptoms for women

Women seem to experience more early symptoms (prodromal) of a heart attack, often more than a month in advance, but the symptoms themselves can be hard to predict. Most of them commonly occur with people who have perfectly normal heart function, but if you carry several of the risk factors listed below, they may be real heart attack warning signs.

Pre-symptoms

  • Unusual fatigue that’s not caused by a lack of sleep, fighting off a virus, or prescription drug side-effects.
  • Sleep disturbances: unusual or nightly difficulty staying asleep.
  • Shortness of breath. This is a useful indicator for women who have not been diagnosed with heart problems before.
  • Indigestion
  • Anxiety

Symptoms during a heart attack

  • When a man has a heart attack, he is more likely to grab his chest. When a woman has a heart attack, she is more likely to clutch her stomach or her head.
  • Chest pain is still a key indicator of a heart attack for men and women, but many women have described other types of severe discomfort (pressure, tightness, aching, burning, sharpness, fullness and/or tingling) throughout the upper body (upper back, neck, arms, shoulders, and sometimes in the throat or jaw).
  • Other symptoms
    • Shortness of breath (dyspnea), which may or may not accompany upper body pain.
    • Weakness or unusual fatigue
    • Cold sweat
    • Dizziness

BaptistOnline site content overhaul

Archer Malmo was selected to completely rebuild Baptist Memorial Health Care’s enterprise website.  I was the project’s principal writer.

BMHC site design sample
BaptistOnline.org

My assignment: Cut the old site’s page-count by half and the word-count by even more, “without leaving out anything important.”
Also: Shape the online brand voice and document it for hospital communications staff to use in site revisions (see below).

  • My first step for editing each page’s content was to move the most useful piece of information to the first sentence or the headline.
  • User personas: Most site copy was to be written in a patient/family friendly style with the understanding that prospective employees and network physicians would be reading the same content for different reasons.
  • I also carried out SEO (search engine optimization) requirements or recommendations gathered in Google Analytics, especially for individual hospitals’ or clinics’ search visibility within their local communities.

My Web Content Style Guide

Like other first-rate hospital systems, Baptist mandates that the writing style in its external communications strike a tone that is serious and modest

  • You think I wanted to rip that rule up and inject some modern energy into the new site copy?
  • Nah.
  • First thing I did was double down on the serious/modest rule. 
  • That’s because it’s perfect for online content on this scale. 

I wrote that serious should be interpreted as caring, informative and respectful, but not formal or technical. And that a modest tone is not only appropriate for health care messaging, but is also smart risk management.

These brand attributes — modest, informative, respectful — also support good practices for writing digital content for any organization. That’s because most people prefer to read web content that is short, easy to scan, and objective — rather than promotional.  This goes for all audiences, as user research* has shown that even highly educated experts in any given field prefer content that is easy to scan.

So here’s the nuts and bolts of my advice to anyone at Baptist tasked with updating their site’s content: 

Keep the language informal. Write your messaging with a natural, conversational tone. Here are contrasting examples of formal and informal introductions of health care services, compiled** by a user-experience research company:

“For over four decades, ABC Health has met the health care needs of the local community. Juxtaposed with clinical excellence and cutting-edge research, ABC takes pride in innovative treatments.”

“At XYZ Healthcare, we don’t just treat diseases, we treat individuals. We put our patients’ priorities at the center of our care.”

Both examples are serious and respectful, but “ABC” takes a formal and matter-of-fact tone while “XYZ” is casual and enthusiastic. The tone of the Baptist voice falls between these two, leaning closer to XYZ.

Where Baptist content differs from both examples is in the priority given to useful information. Our online visitors are not looking for advertising slogans or claims of commitment or excellence. They are looking for facts about our health care services.

Each page on the site starts with its most important fact. Place that fact in the headline, if appropriate. If the site visitor backs out of the page (most do, after three seconds) then they will still have learned the most important message on the page. This approach will also help to front-load that information into search results, speeding the visitor’s path to the right information.

Shorten. The best web writing comes from the DELETE key. If you are copying text from a printed publication or video script, delete at least half of the text. Repetition is important for reinforcing points in seminars, podcasts, and videos, but disastrous for web content.

Follow the rules of grammar, but don’t confuse grammar with style. Our English teachers graded us on consistency in point-of-view and verb tenses. But website visitors grade us on ease and simplicity — on text that flows like speech. So loosen up with these style suggestions:

  • Choose a point of view (us, you, patients) for your text, but don’t be afraid to change halfway through a paragraph or page, if necessary.
  • Change verb tenses wherever necessary. Facts appear in the past, present and future, and there is no reason to contort your writing in order to describe all the facts with the same verb tense.
  • Active voice verb phrasing is often better than passive, especially at the beginning of a paragraph or when you’re asking the reader to take action. But don’t let that stylistic preference make you “bury” the most important word at the end of the sentence. (e.g. “The patient was released from Baptist-Collierville” vs. “Baptist-Collierville released the patient.”)
  • Feel free to use contractions where they make the text flow better, but try to avoid using more than one contraction per sentence or starting a sentence with one.
  • Format your text to be scannable. Elements that promote scanning include headings, large type, bold text, highlighted text, bulleted lists, graphics, captions, topic sentences, and tables of contents.

Sentence length: The original “Twitter limit” is a good goal (140 characters and spaces).
Paragraph length: No more than three regular-length sentences.
Left is right: Site visitors scan the left margin of a page for important information. Don’t hide keywords in the right side of a block of text.
Italics are for print: Do not set entire paragraphs or long sentences in hard-to-scan italics.
Bullet lists help, mostly: Avoid lists made up of single words or list-items longer than three lines.
Numbered lists: Only if the order gives the list its meaning.
List length: Most should fit within one screen view on a phone. Reorganize longer lists into shorter ones, separating them with subheads.
FAQs…keep them real: They seem dated, but site visitors still like to use these towering lists of A-Z information, especially when they don’t know the right words to use in a search. But FAQ lists only work if they are truly comprised of questions asked frequently by your stakeholders, and not made up for promotional tricks.

RETURN TO MY PROJECTS>>


* Loranger, Hoa; Meyer, Kate. Writing Digital Copy for Domain Experts. Nielsen Norman Group website. 2017.05.23.
** 
Meyer, Kate. The Impact of Tone of Voice on Users’ Brand Perception. Nielsen Norman Group website 2017.08.07 (the article used different fictional names for the hospitals) 

National media campaign – Best Cities for Relocating Families

My public relations client,  Primacy Relocation, was the nation’s 5th largest third-party employee relocation management service, with an eye on jumping to the #3 spot.  Primacy contracted Bert Sperling of Sperling’s Best Places to provide quality-of-life statistics on all U.S. cities for its website. My client was also evaluating an offer from Sperling to produce ranking surveys to promote the nation’s best metro areas for relocation, which were eventually named Best Cities for Relocating Families  and Best Cities for Relocating Singles.

The Problem

As public relations lead for my client (via inferno), I was not convinced the baseline, off-the-shelf version of the city-ranking system was going to be interesting enough to generate earned media. It was also not relocation-specific enough to increase thought-leadership credibility for my client.

To be taken seriously, this study had to be entirely about the experiences and priorities of relocating families or singles during their first 18 months after a move to a city.

  • Otherwise, the study would be redundant to the annual rankings published by Money, USA Today, Fortune, and others.
  • It would also be drowned out by novelty surveys produced for Axe body spray (BestPlaces to Hook Up) as well as Most Unwired Cities, Best Places for Termites or Hershey’s America’s Sweetest Cities.

Bert Sperling agreed with us, emphasizing that the most successful rankings contain custom statistics drawn from the client company’s domain expertise.

Action

I reviewed published methodology and criticism of several city-ranking surveys. In order to produce a survey that merits attention from the media and Primacy’s core audiences, we would need to infuse Sperling’s stock data set with an overlay of custom data.

Hassle Factors
What we playfully dubbed RSVPs (relocation-specific variable preferences) were identified through industry research and focus-group meetings with relocation consultants.

The next research challenge was locating nationwide, measurable data on the RSVPs. I was able to locate state-by-state or city-by-city data on hassle factors such as:

  • Customer service ratings at local utility providers
  • Ease of qualifying for in-state tuition at local universities
  • Vehicle fees and taxes
  • Per-capital volunteerism (Why volunteerism?)
  • Prevailing rental fees for mini storage units
  • Suburban sprawl and its effect on navigating around a new city

Unlike many quality of life surveys, ours did not take into account things like professional sports, water/air quality, state budget deficits, performing arts, health care, high school graduation rates, or the number of available flights at local airports—those affect long-term residents, too, so we left them out or gave them less weight in the calculations.

Execution

Once the categories and custom data were prepared, Bert Sperling used his computer models to perform the calculations.

A press kit and e-mail pitch was produced for each survey, distributed to Primacy’s and Worldwide ERC’s regular media lists and via PR Newswire. Custom briefing documents were provided to reporters requesting interviews with Primacy CEO Matt Spinolo.

I gave Matt intensive “re-briefings” in preparation for both of his CNN appearances and I personally prepared and held up special cue cards during the remote interviews so he could seemingly effortlessly rattle off statistics, trivia and our canned jokes.

BUDGET: Sperling’s fee, plus our agency’s billable time and production costs totalled approximately $48,000.

Results

By the end of the campaign, Primacy’s organic search result ranking had improved an estimated 800%.  Business media coverage was absolutely unprecedented for a human resources service.

NATIONAL MEDIA COVERAGE

  • CNN “Open House” live interviews on 9/24/04 and 10/29/04
  • Wall Street Journal Radio Network interview 5/21/04
  • Wall Street Journal’s RealEstateJournal.com 8/10/04
  • Wall Street Journal’s CareerJournal.com 8/10/04
  • CBS MarketWatch – 12/10/04
  • Copley News Service – 10/03/04
  • Investor’s Business Daily (online) 11/11/04
  • Spirit (Southwest in-flight) 3/05

TRADE MEDIA COVERAGE

  • Mobility magazine 4/04 and 7/04
  • Relocation Business News 5/21/04
  • Globility – 6/9/04, HR News (Society for HR Mgmt.) 11/10/04
  • Military Officer 2/06
  • Human Resources Executive 01/05
  • Expansion Management Magazine 10/05

REGIONAL MEDIA COVERAGE

  • Philadelphia Inquirer – 12/13/04, Grand Rapids Press 5/21/04, Evansville Courier 8/17/04
  • Houston Chronicle – 12/19/04, Dallas Business Journal – 10/08/04, Austin Business Journal 5/19/04, News 8 Austin (cable) 11/01/04, Austin Business Journal 11/01/04, San Antonio Business Journal 5/19/04
  • Orlando Business Journal 11/05/04, Florida Times-Union – 02/05/04, Baton Rouge Sunday Advocate 5/30/04, Memphis Business Journal – 07/02/04, The State (Columbia, SC) – 12/14/04,
  • Denver Post – 5/30/04, Portland Business Journal 11/03/04, The California Aggie (Davis) 11/8/04, Puget Sound (Seattle) Business Journal 11/22/04, Wyoming Tribune Eagle 9/8/04

RETURN TO  PROJECTS>>

Why Volunteerism?

While thinking about newcomer pain-points, I jotted down SHYNESS based on a two-part hypothesis (OK, it was a guess):

  1. Some cities have got be more agreeable to shy people than other cities.
  2. Such shy-friendly cities would naturally be more agreeable to any newcomer, shy or bold.

Before devoting any more mental energy to this, I located a psychologist who is an expert on shyness, Dr. Bernie Carducci, director of the Shyness Research Institute at Indiana University–Southeast (just across the Ohio River from Louisville, KY). Bernie confirmed my initial guesswork and helped me to identify metrics with which to rank the cities, which included volunteerism.

  • Bernie explained to me that 95% of the population experiences “transitional shyness” at different times in their lives, especially when they move…”and that the other 5 percent are lying.”
  • The level of volunteerism in a city is a particularly important factor for newcomers, since volunteering for a non-profit or civic organization is a great, low-pressure setting for meeting new people.
  • Volunteering provides a newcomer with a low-threat environment to become involved with a group of potential friends at his or her own pace.

But how to measure volunteerism? I located a database on the website of a national clearinghouse for volunteer opportunities modeled on popular career search/recruitment sites. The database tracked the number of people in every U.S. city looking for volunteer opportunities. Bingo!

Teenage Shyness

The other shyness metric we used was the level of teenage employment as reported by the Bureau of Labor Statistics. This filter was only applied to the “Families” survey, not for “Singles.” If a corporate transferee believes that their teenage son or daughter will be miserable in the destination city, they may not make the move. Teenagers  abruptly moved to a new town can suffer from crippling transitional shyness. Working on a part-time job with other teenagers provides a great opportunity for making new friends or reboot their social skills in a low-pressure setting (unlike high school).

“Hanging out at a mall is a terrible activity for a shy teen,” Bernie Carducci told me, “But working in a mall can be terrific.”