Cover Story
Doctor, What’s the Story?
Saving lives and treating disease may be all in a day’s work for physicians. But for many, talking to the media can be unnerving.
By Kate Ledger
When the 35W bridge collapsed at the height of rush hour in Minneapolis on August 1, 2007, the first medical responders on the scene had one objective in mind: to rescue the drivers and passengers who were still trapped in cars and in the river amid the wreckage. The scope of the disaster was staggering, and emergency personnel worked quickly in the chaos of smashed vehicles and upended concrete to locate survivors and evacuate the injured. John Hick, M.D., medical director for emergency preparedness at Hennepin County Medical Center (HCMC), arrived at the devastation about 15 minutes after the collapse occurred and began working with rescue teams and assisting with triage.
Although Hick was focused on the rescue efforts, he was aware that members of the media had arrived on the scene bearing cameras and microphones. Hick didn’t have time to talk with journalists. “Few of us spoke to the media that night,” he recalls. But the following days were another story. Interview requests poured in from national news organizations and then from international ones such as the BBC and Al Jazeera. Hick and the HCMC media team planned their responses, assigning medical spokespeople to talk about the event, scheduling press conferences, and arranging for certain media outlets to have exclusive interviews with physicians from the medical center or emergency medical services.
Navigating the needs of the media is an important, though sometimes uncomfortable, role for medical personnel, notes Hick, who was one of several people providing updates on the victims and reassuring the public about the work of the response crews during the days and weeks following the crisis. “This was a tragedy, but we had adequate resources to deal with it,” he says. Hick recalls that during the interviews he emphasized the fact that everyone got timely care, that all the emergency personnel worked together, and that they were pleased with the patient outcomes. “I think we were successful in getting those messages out.”
As Hick and other physicians who get calls from the media note, the press is essential to communicating health information to the public, whether it’s updating them about a disaster, interpreting screening recommendations, or conveying the realities of a disease outbreak. Even so, some physicians are wary of being interviewed. Some have felt their quotes were taken out of context or that the subtleties of their research were misrepresented. Others have squirmed when they found their statements hyped into promises of cures for diseases. Keeping the message focused is just one way Hick handles an interview. “There’s basic stuff about working with the media that a lot of physicians are not well-informed about,” he says. As doctors who frequently talk with reporters are quick to point out, certain communication strategies are worth learning because speaking effectively with the media can be another tool in practicing good medicine.
Build a Partnership
Imparting timely health information is part and parcel of the job for infectious disease physician Ruth Lynfield, M.D. As state epidemiologist with the Minnesota Department of Health, she’s often interviewed about the latest disease outbreak, so she works at maintaining long-term relationships with reporters. “It’s really important to partner with the media in order to get accurate, useful information out to the public,” she says. “Often, we need to explain the latest about what’s happening, and we need to get information to people about what they can do to protect themselves.”
The need for such a partnership became overwhelmingly clear during the H1N1 outbreak two years ago, when it was critical that the public understand that the virus was significant enough to merit taking precautions, while not being cause for panic. “You want to get information out to people before they hear about it from another venue,” she says. “We had the ability to provide accurate information, as much as we knew, and if we didn’t provide it, we were aware journalists could get information from places less-informed,” she says. The press was able to help her put the disease in perspective, communicate which groups, such as pregnant women, were at higher risk, and provide information about how to avoid it such as covering a cough or staying home if you had symptoms.
One important tactic she has learned is determining early on in an interview what medical understanding the journalist has and what his or her reporting interests are. She has found most of them earnestly want to help the public get accurate health information. Occasionally, though,“you’ll run into someone whose objectives are a little different from yours, and they’re not as interested in getting information out, and may be more interested in the excitement of the story.” When the first wave of the H1N1 pandemic was over and a fall recurrence was on the horizon, many journalists wanted to write about the worst possible scenario, as if the virus would undoubtedly follow the deadly pattern of the 1918 Spanish influenza pandemic. Lynfield pointed out that pandemics have different levels of severity and that the second wave of this one might not be very severe. When she senses a reporter is likely to focus on the sensational, she invests extra time in the interview. “Spending enough time with the journalist and making sure that they understand the situation and that their questions are answered goes a long way toward being sure that there’s not a confused message,” she says.
Earlier this year, when a longtime health journalist whose knowledge base and reporting skills she trusted was seeking information on the measles outbreak in the state, she readily answered questions. She was pleased to see that the piece that ran in the Minneapolis Star Tribune focused on the case of a child who’d spent two weeks on a ventilator in the ICU because of measles-related pneumonia. This was important as it illustrated the consequences of not immunizing children. “This was a story that let people know that this is an illness that can be very severe and is worth preventing,” Lynfield says.
Taking the time to talk with reporters is also a priority for forensic pathologist Lindsey Thomas, M.D., of the Minnesota Regional Medical Examiner’s Office. “When you’re in forensic pathology, there are cases and issues that are inherently interesting to the press,” she says. When reporters want the scoop about an unusual death, her main objective is to stick to facts that she can legally share. Although not bound by national HIPAA requirements, which protect patient privacy, medical examiners are limited by Minnesota’s laws and must refrain from divulging certain information such as blood alcohol levels or the number of bullet wounds. “We take that seriously,” she says. Even when reporters push with more questions, “you have to stick to what you can say and not speculate.”
What’s often helpful, she finds, is providing context. “The details of a homicide you can’t give, but you can say, here’s how the office investigates a death, here’s what we’re looking for,” she explains. “You’re providing useful information without giving a lot about the specific case.”
When the relationship with the press is working well, she adds, a knowledgeable, keyed-in reporter can do wonders to illuminate an important health issue. A few years ago, amid a rising number of infant deaths caused by accidental suffocation in bedding, then-WCCO reporter Caroline Lowe became interested in the topic and interviewed Thomas and other forensic pathologists. “We described how we interact with families and how we investigate infant deaths,” Thomas says, recalling being concerned that the report would hit a nerve with parents devoted to having their babies in bed with them. “We were just saying, ‘Here’s what we see and how awful it is when we have to tell families why their child died.’ She did a very sensitive but educational piece promoting safe sleep.”
Stick to Your Message
The fact is, says David Hilden, M.D., an internist at HCMC, interacting with the media effectively isn’t usually part of a physician’s training and involves a learning curve. “Most doctors are taught a little bit in medical school and residency about how to communicate with their patients, but we get almost no experience in dealing with the press.”
Hilden, who offers his services to the hospital’s public affairs department, was surprised when reporters called on him to discuss an array of medical topics or to comment on the latest health issue in the news. “I think the role of a physician in that case is to provide context and perspective on the story, for example, a new study that people need to exercise more. You provide context to help people understand why they should care, and you choose your words carefully so that you don’t come across as alarmist.” Moreover, he has realized how important it is to keep the latest medical evidence in mind when speaking, so he makes it a habit, if there’s time before an interview, to brush up on the most current information. When a reporter called recently for an interview about vaccines and autism, Hilden only had a few hours’ notice, but he took 10 or 15 minutes to look up the latest research. “It confirmed in my head that there is no link,” he says. “When I gave the interview, I could give some information based on fact, and it wasn’t just my opinion.”
He also learned early on that it’s important when speaking with reporters, particularly for television, to get to the point quickly. “You have to know going in what your message is,” he says. “What is it that you want your listener to take away? And you have to stick to that.” A long, contemplative introduction or a speculative interpretation (the kind a physician might offer at a medical conference) is likely to get edited out of a two-minute nightly news segment, and the critical information the public needs can get lost. “You want your message right up front,” he says. “You don’t want to give a lot of qualifiers.” What’s more, physicians who don’t get to the point can be surprised when they see their much-chopped quotes. “You see it and think, I was much more eloquent than that!”
In addition to fielding requests from reporters, Hilden does a live radio show called “Healthy Matters” on Sunday mornings on WCCO AM, during which he talks about health issues and takes calls from listeners. Because listeners introduce topics during the calls, he isn’t able to prepare as he would for a reporter’s interview. “I think it’s important to say when you don’t know something,” he acknowledges. “If you’re humble and you can say, ‘Well, you’ve really stumped me,’ that really goes a long way.” Appropriate humility from a doctor is helpful for the public, too, he adds. “One of the realities of being a physician in our society, is that people—rightly or wrongly—tend to listen to us.”
Learning the Hard Way
Interacting with the media tends to get easier with experience, note physicians who do interviews often. But crucial lessons sometimes come out of painful incidents. One that neurologist Mark Mahowald, M.D., still can’t forget happened 20 years ago when he was interviewed by a reporter from the Village Voice. An East Coast colleague passed his name along, and Mahowald agreed to comment for a piece the reporter said was about the importance of animals in biomedical research. Mahowald, who directed the Minnesota Regional Sleep Disorders Center and is now a visiting professor of psychiatry and behavioral medicine at Stanford University, says his lab had made inroads in the study of people with abnormal REM sleep, “and we couldn’t have done that if it hadn’t been predicted by animal models in the 1960s.” But the published article shocked Mahowald. It was staunchly against the use of animals in research, and quoted Mahowald as though he agreed. “It was the exact opposite of what I had said,” he says. There was no recourse for the misquote, he decided, nor was it worth getting involved in a lawsuit against the paper. But the incident did prompt him to be more cautious about accepting interview requests.
These days, he’s as careful as he can be to find out who’s doing the interview. He asks the public affairs department to vet publications he’s never heard of and turns down invitations to appear on certain television shows if he feels they’re sensationalistic. When he is interviewed for publications, he asks to see the text before it goes to print. “Most of the higher-end periodicals and newspapers will let you look at an article and check for accuracy,” he says. “You should always ask.”
There are lessons to be learned, others point out, even when the media exposure goes well. Hick, for example, discovered something following the collapse of the 35W bridge that he hadn’t realized before, despite his extensive experience with the press: not to put staff in front of the cameras and microphones too soon. During the days after the incident, several medical spokespeople had trouble staying composed in front of the cameras. “In hindsight,” he says, “we probably shouldn’t have put some people in front of the camera. They were too raw, they were still choked up. Because they didn’t have a lot of media training or background and, because of the intensity of what they’d experienced, there was a lot of emotion, and they just couldn’t go on talking. If you’re going to do an interview, you need to feel you’re not going to be injured as a part of it.”
Part of the Job
Gary Schwitzer believes that even if physicians may not seek to be in the public eye, they have a responsibility once they get there. A longtime health reporter who later worked for Mayo Clinic, Schwitzer was a professor of journalism who taught health care journalism and media ethics at the University of Minnesota until last year, when he left to devote himself to his passion: running the media watchdog website he started, HealthNewsReview.org. The site grades health-related articles on such factors as whether the reporting is balanced, the information is accurate, conflict of interest is disclosed, and whether it contributes to sensationalistic disease mongering. “It’s not your responsibility as a physician to ensure, because you have no control over that, how the filed story comes across,” Schwitzer says. “But we all have to think what our ultimate contribution is to patient or public understanding.”
For physicians, one of the primary responsibilities is not to opine on a topic but to present evidence-based information. Too often these days, he says he sees physicians, particularly those on television shows, standing in as journalists. But then they give opinions that become promoted as “news.”
Another critical responsibility, he says, is to help the public understand subtler concepts such as the tradeoffs between the potential benefits and side effects of treatments. Training in how to convey risk would be helpful for most doctors, Schwitzer believes, and would benefit society as a whole. In the recent reporting on findings that prostate cancer screening puts men at risk for unnecessary procedures, physicians had an obligation to explain the issues to a public that surveys have shown “believes that in health care more is always better, newer is always better, screening always makes sense for everybody,” he says. “We have to ask ourselves, ‘Are we guilty of simplifying and promoting false certainty, when we ought to be admitting, and grappling, and helping the public understand the rampant uncertainty that exists?’”
Don’t Go it Alone
Many medical institutions have media personnel who will help a physician run through possible questions before an interview or even teach strategies to elucidate the key message that will be helpful for the public. Mayo Clinic’s Mary Jurisson, M.D., a physical medicine and rehabilitation specialist, found media training helpful as she began doing interviews about topics ranging from arthritis to rehabilitation for patients having hand transplants. She notes that physicians tend to think like scientists and often see all the nuances rather than the single message that consumers need as a takeaway.
Jurisson admits that when she first began doing media interviews she struggled to determine the most effective points and questioned whether they could be expressed accurately while being concise. A session with the public affairs department helped her learn to encapsulate the information that was most relevant, and that, she says, has alleviated some of the stress that goes with doing an interview. “I’d never anticipated giving interviews,” she says. “It wasn’t that media training gave me sudden confidence—but I didn’t have to go it alone. It was a huge relief to know I could get help.” MM
Kate Ledger is a St. Paul writer and a frequent contributor to Minnesota Medicine.