The Language of Buy and Sell

I've just attended a grant writing seminar in which we learned how to improve our grantsmanship. Looking at the course from the biggest perspective, the speaker taught us to consider an application from the perspective of the reviewer and funding agency. To imagine that the reviewers are reading these because they have to, not because they want to, and are likely to be doing so in a plane, or early in the morning, or at a soccer game... He highlighted the need to make them readable and accessible to a wide audience. He made an analogy to sales, where the grant application is your opportunity to sell the reviewer and funding agency on your idea. The application should tell them "what they are buying for their money."

Although I have never been a grant reviewer, I can easily imagine how difficult it is to read through many grants looking for the right one to recommend and defend in front of colleagues and philanthropists. I also think it's appropriate to extend this analogy to our interactions with patients. How often do we really communicate to our patients what they are "buying?" And I'm not talking about money. What are they buying with their time, blood, alopecia, nausea, pain, fevers, diarrhea, rashes, fatigue ... and cognitive fog? After all, would any of us spend $4,000 dollars for a new refrigerator without a very clear understanding of what this particular refrigerator is likely to do for us? Should a $4,000 dollar bottle of erlotinib be any different?

This is essentially a different way of framing an informed consent discussion. I can extend the analogy beyond the patient/doctor relationship to that of insurer/clinic too. The payer (insurance company, HMO, patient) are paying an oncologist a great deal of money for every visit, scan, treatment, lab draw, radiograph ... So what are they buying for their money? Certainly for your advice on diagnosis and management and they have an expectation you will provide high-quality care taking into account response rates, symptom management and survival benefit. Insurers are also probably paying for cost-conscious care. I think patients and payers would also pay for my guidance through the peril-filled and uncertain maze that is oncologic health care, full of unexpected events and detours.

It's a challenge to think of our daily life from the perspective of the patient, or from the vantage point of the payers. But, I suggest, that it may help us provide better care if we occasionally give serious thought to the other perspective.