Venturing into the world of choosing a freelance medical writer can be daunting. There are writers with specific subject-matter expertise, writers who specialize in certain types of writing, and writers with varying degrees of experience.
Below are helpful interview questions for finding an independent medical writing partner who can become an ongoing resource!
Experience: Not all medical writers can write for advisory boards. Some writers are excellent at writing patient education materials, while others belong eyeballs deep in a regulatory document. Advisory boards are almost never recorded, and the tight deadlines and fast-moving discussion (over the course of several hours) call for an experienced writer.
A Client-Facing Professional: A medical writer is representing your company on site and should be able to support your relationship with your client. A great writer doesn’t have to be a flaming extrovert (and many aren’t), but they do need to be able to confidently interact with your team and advisors in a professional manner.
Flexibility. Ask the writer if they are willing to come early to make sure that the room is in order. This is a great way to weed out people who have “not my job” syndrome. If a writer tries to negotiate an extra fee for this or balks at the idea of helping for 30 minutes, move on.
A note on areas of expertise: Many times, a client will ask for a writer with expertise in a certain area. This can get tricky when you’re looking for someone with meeting and subject matter experience (especially when it comes to rare diseases). While experience with unrecorded meetings is critical, there’s a little more wiggle room with subject matter expertise. Most medical writers have advanced degrees and are able to get up to speed in most areas relatively quickly. A writer with any amount of experience will do “homework” ahead of the meeting to be sure they are ready. The meeting slide deck is an excellent guide, and providing it ahead of time (even if it is a draft) can help the writer be prepared.
The above questions should make it easier to find a medical writer to help you get the most from your meeting. Medical writers can be great allies on site, and they should also add value to your meeting to help keep insights at the forefront and keep the momentum going. Hopefully this article helps you find a perfect medical writing partner!
The hardest thing for me about the transition from laboratory scientist to medical writer was that there were still so many wonderful questions about 2′-5′ oligoadenylate synthetase I wanted to ask. Yes. I am not making things up. It was break-up level hard. The second hardest thing was going from a job where I was nearly always on my feet moving flasks and tubes around to one where I am parked at a desk all the time. I laughed the first time I saw a treadmill desk. Now, I get it.
I am not going to write about why exercise is important for your health because DUH. “Sitting is the new smoking” is a catch phrase for crying out loud. I will say that I can easily get another two hours of good writing in each day if I exercise in the morning and then again for 30 minutes at around 2:00. Free productive time! Just for exercising! I’ve listed some of the things I do to keep myself from withering away in a desk chair.
1. Pack your gym clothes! If you go to a coworking space, find a nearby park or gym you can go to. There’s nothing like hauling around your clothes to remind you to go! If you travel, every hotel has a gym. If I get into town before 8 PM, I work out at night. Otherwise, I’m up at dawn to go to the gym. It really helps keep me sharp. I also don’t come back into town all cranky from not having exercised for two days. Even better, more and more hotels have running maps so that you can go on a scenic run. For business travelers with all of eight minutes to explore the city, this can be a great way to get out and get your blood flowing. At the very least, I stretch in the evening and in the morning to try and combat having been stuck on a plane and sitting through a day-long meeting.
2. Toss the desk chair! I have a standing desk and a yoga ball for when I need to sit down. When I go to my coworking space and use the chairs there, I can really tell a difference in my posture and how I feel at the end of the day. There are times when I am working on something really complex that I like to sit. If I do that, and I know I’ll be at my desk all day, I set a timer so that I can get up and jump rope. As a side note, five straight minutes of jumping rope is a lot harder than it sounds!
3. Walk it out. If I’m frustrated or depressed because I’ve been writing about cancer all day, or even just regular old sick of what I am writing about, I take a walk around the neighborhood. People love to say they don’t have time, but it is a great way to push the reset button and to spend some time outside.
4. Stretch. The nice thing about working from home is you can throw a yoga mat on the floor and set a timer to go off every hour and a half so you can stretch for 10 minutes. Heck, most of us are already wearing yoga pants right?
Keeping your body in good shape is important, especially when you’re asking so much of your mind.
Usually, advisory boards are dynamic exchanges between physicians who are at the top of their field. That’s part of the reason that I love to write executive summaries. Capturing the perceptions of advisors is critical for the companies who host these events because they have no other way to truly understand the needs of physicians and their patients.
Sometimes, however, there’s a live wire in the room. I don’t mean passionate. I don’t mean that they are sharing an honest yet unfavorable opinion of the drug. I’m not even talking about the advisor that bangs their hands on the table when they start talking about a mind-numbingly long prior authorization process. No. I am talking about an advisor that repeatedly pokes holes in the discussion with inflammatory, sarcastic, or worse, repetitive comments. They are rare (thank goodness), but they are out there.
This happened once when I was covering an advisory board for a drug that was a great option for patients who could not tolerate an established generic medicine for treatment of a serious chronic condition. There weren’t that many patients who seemed to need the newer treatment right away, but to be fair, for ages and ages, physicians who had been treating this disease hadn’t really been on the lookout for signs of drug intolerance because there wasn’t really any other treatment option.
One of the advisors, who was clearly an experienced physician, practiced in a rural area where many of his patients would struggle to pay for a new drug, even if they needed it. He was not particularly interested in ‘potential advantages,’ as they had only been demonstrated in a similar disease, and he made that known in no uncertain terms. This isn’t really an issue by itself, but every single time conversation would get going, he would put it to an immediate stop to it by taking over and repeating a point he had made earlier in the discussion that ended with a statement that in all cases, the generic was sufficient.
It was a disaster. After about 30 minutes, he had sucked the life out of the room. By lunch, the moderator, who I’d seen wrangle a tangent or two quite skillfully, was obviously exhausted. Following the post-lunch coffee break (if you’re a meeting professional, everyone really appreciates that coffee break), the discussion turned towards potential risks associated with high doses of the generic medication. Once again, the group touched on those ‘potential benefits,’ and the troublesome advisor finally blew a gasket.
Moderator: This drug could be a really important part of mitigating risk for patients who need higher doses of generic medicine X.
Dr. A: Yes, I think we really need to consider the potential bene—
Dr. Live Wire: I’m a marine, I don’t give a shit about risk!
Dr. Live Wire had finally crossed into whatever territory four year olds occupy when they need a nap.
What to do with a live wire? I have been in a meeting where the head of medical affairs has pulled an advisor aside to point out their behavior. In this instance, it helped. She simply stated “I’ve noticed you have some really strong opinions about this. We want to know about them, but we also want to hear from everyone else. Is there anything I can do to help that happen?” It turned out that the advisor had lost a patient that morning. After traveling from across the country to come to the meeting, he was depleted and his feelings were coming out, like it or not. Having the effects of his behavior pointed out in an empathetic way was enough to stop it.
I’ve also approached a moderator during a break to say, “I know there’s a lot going on today, but I just wanted to let you know that I have a lot of notes about what Dr. Live Wire thinks, but not much from everyone else.” Moderating conversation can be stressful, and it can be hard to see a dynamic emerge in the moment. It turned out the moderator was a subject matter expert himself, and was contemplating points of the conversation while moderating (talk about multitasking!) and simply hadn’t noticed the lopsidedness. He was able to redirect conversation pretty easily after that.
It may be that simply announcing that you’ll call on people to answer questions from now on is enough to minimize stray comments from the live wire. Once you get some information, you can open the floor up for additional comments. You can be sure Dr. Live Wire will have something to add.
The other night, I was sitting at the table with my four-year-old daughter, who informed me that dinner was ‘disgusting.’ Nice, right? To combat this show of ingratitude, I then turned into my mother and said, “If you can’t say anything nice, don’t say it at all.” She then lowered her voice to a whisper, and said, like she was telling me a secret, ‘I really hate this dinner.’
This little gem isn’t going to be followed up with any amazing parenting advice; I’m just another person morphing into their parents while trying to make a kid eat vegetables! I offered up this bit of my personal life to illustrate a point. Companies are like families. Sometimes when you show up as a dinner guest, it is a complete delight. Everyone is working hard together. They like one another, and if you ever traded in your own family (or your freelance business), you’d want them to adopt you.
Other times (rarely, I should add), you show up and there’s an argument at the dinner table that ends in someone getting hit in the face with a roll. The advisory board version of this could be a disgruntled medical director says something really harsh about another team member over a platter of turkey sandwiches. The energy in the room is tense. Eyes are rolling, people are not friends, and they are not accomplishing any meeting objectives because they are so embroiled in making their opposing points that the advisors aren’t really able to freely contribute. The manuscript version of this involves e-mails between colleagues (on which you are cc’d) that start out as constructive but eventually devolve into a document merging disaster that includes conflicting comments and directions from each person.
So what is a freelance medical writer who just flew into town yesterday to do?
Remember, if you’re at a meeting, you are there to make sure that the company gets the most from the meetings they host, not solve internal problems (there are consultants who specialize in that). Don’t worry if someone unloads their frustrations on you; there’s nothing you can do about it. I do what I can to make sure whomever I am talking to knows they’ve been heard without necessarily agreeing. For example “John is such a bore; he’s completely off track,” can be met with “Hmmm, it’s always hard to keep an eight-hour meeting on track the entire time. Just think about what a mess one-hour phone calls can be!” Done. You heard them, you connected, and you didn’t say anything mean about anyone.
I once asked my contact at a medical device advisory board a question about the deliverable, and he said in a sarcastic tone, “Ask Jane. She’s in charge.” Even though I was a little surprised, I decided to play tone deaf. I said, “Oh, okay! Where can I find her?” I’ve gotten out of a number of weird situations by just taking into account the words said, while completely ignoring tone of voice.
I once showed up to an advisory board where the organizer was at odds with one of the directors of medical affairs. The director asked me when I walked into the room, “Who are you?” Not in an excited way, either. I smiled and introduced myself as the medical writer for the advisory board and she said something like, “I don’t know that we really need that.” She was being mean and trying to flex her muscles by pushing around the only person in the room she could. Me. So, even though I really wanted to just leave, I said “Well, hopefully after this meeting, you won’t be able to remember how you lived without me. Let me know if there’s anything I can do to help.”
If you are working on a different type of project, like a deck or manuscript, the biggest protection against the fallout from internal discord is a well-constructed contract. Usually, I include a clause that says that after the first draft is submitted, I can bill for a percentage of the total fee. If internal problems lead to a lack of agreement on revisions, a dramatic change in direction on the project, or even a project that just dies, you can wait a couple of weeks and just bill for the project and wait for them to get back to you. If the project changes directions, you can bill for the first draft and then write up a contract for the new project. An example of this would be a backgrounder that morphs into a slide deck. Of course, billing for the first draft is not so you can cut ties and run away, but to keep you from getting hung out to dry because of the shifting sands inside your client’s company.
Another thing that I do in my contracts is specify the number of revisions that are included and put in writing that “two rounds of revisions” does not mean that I will merge revisions from twelve different people, twice. In my experience, even people who work together beautifully can offer conflicting advice, so I always let my clients know that if their team gets together to compare notes before sending revisions over, it is a far more efficient use of resources and time and will dramatically reduce the number of e-mails that land in their inbox about the project!
If you are protected by your contract, it is a lot easier to keep cool and navigate any internal issues. I tend to treat snarky e-mails the same way I treat snarky comments in person. I take the comment at face value, respond, and move on. It isn’t worth it to try and correct the situation. All you can do is ask clarifying questions about what it is the client needs from you and be clear about what it is you are willing to do for them.
The good news is that most clients are amazing and will thank you a million times for helping them out of a deadline avalanche or making sure that they meet their communications goals. It really is rare that I feel like I am caught up in dysfunction. As basic as this sounds, being kind and positive can pretty much get you through the most difficult internal dynamics. The client will remember you as being a delight to be around, and you can know that you didn’t do anything to promote counterproductive nonsense at your client’s company. Unfortunately, contractors sometimes end up on the receiving end of internal frustrations. It’s not you. Ignore it and do your best anyways!
When I first started out as a medical writer, I was a research scientist dabbling in communications. I thought medical writing was all about organizing facts in a way that made sense. Kind of like organizing reagents so that your experiments work. As I gained experience, I found myself writing about different diseases and drugs and sitting in on more and more meetings. I started to connect with the material.
Especially when I work on rare diseases, I can see how important it is to physicians to finally be able to do something for their patients. When I write for diabetes advisory boards, I can see how physicians are constantly searching for the “thing they can say,” to get their patients to try exercising. Even though I know I am writing for a business, I am also writing for physicians and patients. I am part of a process that keeps the lines of communication between pharmaceutical companies and the people they serve open. Without clear communication, the company may never know how to reach the people that need to be treated or how to best communicate research findings with clinicians.
I believe that part of what makes me good at my job is that when I am writing about something, I am 100% dedicated to it. When I write about any disease, I immerse myself in information about the patients, the conversations they are having with their doctors, and how the doctors are thinking about treatment. I eat and breathe the mechanism and outcomes. I take on the objectives of the meeting or the outcomes reported in a publication as my own. The downside of dedication is that the struggles of patients with their disease, and the struggles of physicians with the medical system in general, can really eat me up. There is no elegant way to say it: it can be so very sad.
Research made me frustrated sometimes, but never really sad. I’m sure any MDs who might be reading this are rolling their eyes, because they dance along the line between empathy and self-sacrifice all the time, but as a medical writer, that feeling was new to me. So, if you’re a writer and you find yourself feeling down about how stupid it is that physicians have 6 minutes to spend with their terminally ill patients, or that the only available medicine for disease X costs $15,000 a month, you’re not the only one.
What to do? General self-care practices are a no brainer, so I won’t review the importance of diet, exercise, breathing, and milling around a museum every so often. It’s also important to develop the tools to be able to identify when you even have the medical writing blues. I always know I’ve got a bad case when my views on life take a fatalistic turn and I find myself feeling down after writing. When this happens, I do three things:
These things not only make me feel better, but ensure that I am recharged for my next advisory board or meeting, so I can shake off any cynicism and approach new objectives with refreshed energy and drive!
Most of the time when I am contacted to cover a pharmaceutical advisory board, I sign a nondisclosure agreement before I even discuss the nature of the project with the client. It protects them, but it also makes things easier for me. I like to put my name on something that gives me a solid reason to say, “I can’t talk about that.” I don’t like to tell my clients no, so if I say “I’ve written a lot about disease X,” and they ask, “Which drugs?” I can respond with “I can’t really say.”
Some of my family members are doctors, and I have done a lot of volunteer work in medical settings. During my training at Emory, I participated in an extensive ethics program that covered everything from top-secret lab notebooks to confidentiality and research with human subjects. All of these things gave me a pretty healthy intuitive sense of how to behave. But there are some things that I’ve learned that are important for anyone writing for an advisory board to know that I have added to my own mental medical writing ethics handbook. Especially if you are a freelance medical writer, this is important! If there’s a crowded disease space, you may end up writing for competing companies and not even know it.
Organize all materials provided to you by the client the moment you get them. This is just good practice, but a whole bunch of junk on your desktop or scattered around is not good. Let’s say that you’re asking questions about a particular slide and whoever you are talking to notices that you have 15 other advisory board documents on your computer in plain view. Even if you don’t have two diabetes clients, companies can have products in more than one space, and you might not even know it. Also, anyone seeing their competitor’s name on your desktop now knows how poorly you are handling their top-secret information.
Don’t talk about what you are working on. You never know who you are talking to, or even near. Do not go out to dinner and gripe about work by telling your best friend that you are writing about a drug for disease X and the company is doing great/failing/freaking out because of Y. The guy behind you could be the king of your client’s biggest competitor. Your best friend could go to a barbecue in three weeks and try to impress some guy she just met who is a resident at the local hospital by spitting out the only thing she heard about medicine recently (ie, all the stuff you told her about your client). What if that resident’s advisor was a PI in the clinical trial you discussed? Save yourself some grief and keep your mouth closed.
Protect your computer, cloud, and external hard drive. After I finish a project, I usually put the file containing all the materials onto an encrypted external hard drive. I never work on public computers, even to send e-mails. This aspect of my work is important enough to me that I don’t even try to figure out what I need in order to protect information on my own. I have a trusted “computer guy” who knows more about it and keeps up with the changes in the field. I worry about keeping up with my clients, and he takes care of making sure I don’t inadvertently compromise information by being a computer security amateur.
Because 95% of my writing is for advisory boards, I can’t share any of it when a new client asks me for samples. I have never had client who didn’t understand and appreciate that the medical writer they are about to hire respects confidentiality. Some of the articles and white papers I’ve written are public, and often, meeting notes from societies are alright to share (I know because I ALWAYS ask). When I do really need to provide a sample, I have carefully selected de-identified documents. I remove the name of the client and/or communications company that hired me if it’s there; I include only a small portion of the document; I modify reports that are at least 12 months old; I remove the names of any participants; I change the name of the drug (or any other drugs that are used to treat the same disease); and I change the name of the disease. After I do this, I send it to my editor to read through so she can make sure that even the most maniacal spy in the world couldn’t figure it out. Because the people asking you for the sample are just making sure that you know what you are doing, a few pages is usually more than enough.
Social media. I am not an expert here. I opened a Facebook account in college and promptly forgot about it. That said, I have been in a room where an employee of a competitor commented on something on research gate, and the secret he inadvertently gave away became a brand-new point on the agenda for the day. This is another iteration of keep your mouth closed.
When in doubt, shred it. Most of the time, there is someone responsible for collecting meeting materials. I’ve even been in meetings where specialized security teams make sure that all printed material is returned to the pharmaceutical company to be shredded. If you walk out of a meeting with an agenda, a seating chart, the flip chart pages, or something like that, it is your responsibility to make sure that it never sees the light of day. Do not recycle it in your room or throw it in the trash at the airport. The first thing you should do when you get home is check your bag for materials and shred them immediately.
It is possible to share your experiences and network effectively without mentioning a single drug name. You don’t even need to disclose disease states if you make sure to have carefully chosen de-identified samples, or even swap stories with your clients without putting any confidential information at risk. For example, I have found in my travels that flip charts in the front of the room are rarely helpful. No one likes to watch someone else write on a flip chart. I can easily share that information with my clients without compromising confidentiality.
When I am writing large reports that compare and contrast information gathered from a series of meetings (i.e, different regions or specialists), I sometimes sit through the same advisory board over and over.
Sometimes, when I am covering ad board #9 for product X, it’s hard to maintain the same enthusiasm I had in the first meeting. I know, every freelance medical writer out there is thinking, “you’re not supposed to tell them that!” I get it, but I think it is goofy to pretend like the medical writer in the back is still on the edge of her seat while hearing the same talk for the 9th time. By then, I know all the terminology, I know what the meeting questions are, and I can crank out a report that is exactly what the client wants in less time than when I was writing it up the first time. For a person who loves a challenge, the thrill is gone.
Of course, it goes without saying that it is important to act like a grown up and perform well in spite of your feelings, but I think it is important to recognize that this lukewarm autopilot zone can be a dangerous place to be. Pre-formed expectations can make it harder to really hear: though I can guess at what advisors might say, that’s not the same as hearing what they actually say. Even more dangerous, I start to notice my own opinions creeping in about marketing strategy or when the best time for drug X is for subgroup Y. I am an analytical person. I can’t help it. But, the writer’s job is to stay objective and listen, not to advise.
Know the warning signs of writing complacency
If my energy and enthusiasm for the subject fades, or I find myself having an internal dialogue while I write that is straight up boring, I try not to lose sight of the fact that an advantage of hiring a freelancer is objectivity. I haven’t been working as a medical-science liaison for the company for two years. I don’t know the internal history or what didn’t work for their marketing 5 years ago. All I am there to do is listen and make sure that insight makes its way into my writing. My job is to give the members of the client’s team efficient access to the meeting’s insights.
Part of what makes me good at this type of work is some distance from the subject. I haven’t been treating disease X as a physician for years, and I am not an expert in the company’s marketing and development strategy. This allows me to truly hear what advisors are saying. When that distance and newness gives way to familiarity, it takes more work to maintain the same high level of attention and diligence.
How to maintain focus and interest
So, how do I maintain focus and interest? Aside from reminding myself that ad board #9 is important to my client (and therefore to me), I play a game in the back of the room called “getting smarter.”
Search for deeper understanding
As the presenter is reviewing the same presentation I have already seen half a dozen times, I think of ways to deepen my understanding. One example might be “Wow, there sure are a lot of treatments for diabetes. When was the first one approved by the FDA? Who invented it?” I write down the question and I might research it further during my scheduled “reading time” that I have in place to keep myself sharp. This keeps me interested and engaged in the subject, and I pay closer attention because I am looking for new ways to dig deeper and learn more.
Engage an advisor during a coffee break!
Another similar strategy is to think of questions to ask the advisors during breaks. Now that I know a thing or two about the disease and its treatment, I can ask the advisors themselves questions. For example, ” I heard you say that patient compliance with drug X is really horrible. I’m curious; why do you think that is?” Sometimes I can even go beyond satisfying my own curiosity and I am presented with information that can go in the report! I always indicate that this came about in a break-time conversation so that no one has to wonder why they don’t remember it. Sometimes we talk about mechanism, and sometimes about the advisors’ practices, or even their hobbies! These conversations with advisors are always enjoyable; these are people who are at the top of their field.
However it happens, maintaining engagement with the story unfolding in the room and the people sharing their perspectives makes me a better writer. It’s a win-win-win-win-win!