Physician ethics still in play when talking to the media

Journalists seek comments from physicians for background on scientific advances, for better understanding of the true threat of an epidemic outbreak, for information on the health status of a prominent person and much more. How should you handle interview requests?

Reply:

Torn between a career in medical management and medical journalism, I accepted an internship at The Wall Street Journal to explore my options. On the first day, my assistant bureau chief began my orientation by asking "You know what I hate about doctors? They always introduce themselves as 'Doctor So-and-So.' When I introduce myself, I never call myself 'Mister Such-and-Such.' " I felt as if I alone was bearing the weight of all my colleagues' sins. But this valuable lesson into how physicians were perceived by many journalists was reinforced during my 15 years in medicine and media.

Journalists are taught to be suspicious of authority; after all, they are public watchdogs. Physicians head the list of the suspicious: We drive fancy cars, play an unreasonable amount of golf, have power by virtue of our uncommon expertise, wield mysterious-looking tools and speak in a foreign language -- medical-ese. Physicians should jump at the chance to close this gap in trust by responding to media calls for many reasons.

The most important reason is to help people. From a public health perspective, the reach and impact of media information is unmatched. Physicians can work with the media to further patient education, a paramount clinical goal in this age of chronic diseases. Secondly, physicians are the indisputable experts of the practice of medicine, so their refusal to participate in the debate opens the door to the comments of the less knowledgeable.

We are up against a lot. There's the demystification and creation of unrealistic expectations fostered by televised drama, both reality and scripted. There's HIPAA, which severely restricts a reporter's access to story ideas, development, research and execution and increases the desperation for medical story contacts. There is cross-pollination of beats: a terrorism reporter covering an anthrax scare; an entertainment reporter covering a celebrity's surgery; a security specialist covering SARS -- these reporters may know next to nothing about medicine. Finally, the wide availability of medical information and direct-to-consumer marketing has led to increased patient desire to participate in decision-making about health care.

Given the media's status as the single most powerful influence in contemporary society, we have three options: Follow it. Lead it. Or get out of the way.

Following it has gotten us in trouble. Examples abound of study reports that showed an increase number of deaths related to the use of certain medications -- without placing the studies in context. Almost immediately, physician offices were swamped with phone calls, walk-ins and patient appointment requests that took months to stabilize.

Getting out of the way is another losing proposition; it puts medical information and advice in the hands of nonmedical folks who don't have to worry much about real-life consequences of an often-confused and frightened public.

Leading, therefore, is the only option. Here are some tips:

Define yourself. Say and spell your name as you wish it to appear. State your degree, specialty and affiliation clearly. Be generous with business cards and your cell phone number.

Befriend the reporter. Spend one minute learning about his or her background in medical reporting. Spend two minutes off-camera or off-air educating him or her briefly on the topic of which you are about to be interviewed.

Understand deadlines. You will probably be contacted for a daily turn -- that means you have only seconds to consent to, and minutes to prepare for, the interview for a story that will run that day. The request may come when you are booked solid. Only you can decide to consent. But if you do, you are obligated to do a thorough and knowledgeable job.

Understand the medium and the burden of representation. Like it or not, you represent all physicians. On television you will be judged less on your knowledge than your appearance, body language, comfort level, grooming and likeability. When speaking on the radio tone, articulation, use of common terms and ease of language are important. With print reporters you can talk at length and even correct yourself -- a luxury not often offered in electronic media.

Present the message in a fresh light. Instead of talking about the consequences of diabetes, offer the reporter a glimpse of a patient undergoing dialysis. It's true: A picture is worth a thousand words.

Don't blow it if you don't know it. Stay within your area of expertise and refer the reporter to a colleague when you reach the perimeter of your knowledge.

Present a balanced picture. If an important issue wasn't addressed, such as insurance coverage of this new procedure, speak up. The reporter may not have considered that angle.

Bridge context and perspective. One is far more likely to die in a car crash than an airplane crash. The results of one study of 15 patients may be encouraging, but will probably not become the definitive community standard of care without a randomized clinical trial.

Remember, the story will be told whether or not you are a part of it. Either way, you surely must deal with the information that is reported. Help shape the reaction of your patients.

Prerna Mona Khanna, MD, MPH, clinical associate professor, University of North Texas -- Health Science Center, Fort Worth, internal medicine, public health and occupational medicine; contributing medical editor, KTVT CBS 11 News, Dallas-Fort Worth; Health video guide, About.com

Reply:

Most of the proliferating news outlets seek experts to expound on the wide variety of stories they cover on all aspects of our lives. It is not surprising that news agencies look for physician experts when a story has a medical focus. A Gallup poll of 1,090 U.S. voters taken last December revealed that among professionals, physicians ranked third for honesty and ethical standards. Although most physicians are adept communicators, interacting with the media is not a skill commonly included in the medical curriculum. As a physician with 13 years experience as a medical correspondent, I've identified several attributes of an informative and credible interview:

Accuracy. Medical knowledge is constantly evolving. The recent refinement by the U.S. Public Health Service regarding aspirin prophylaxis for colon cancer is one example; the change in recommendations for hormone replacement therapy in postmenopausal women is another.

Accuracy implies up-to-date evidence-based guidelines or recommendations. If these guidelines don't exist, then the information should be verifiable and carry the weight of being standard of care. Physicians should use the same rigorous standards when educating the public that they use when applying medical research to patient care.

Objectivity. Physicians are regularly consulted about the medical and ethical ramifications of controversial research. Unfortunately, some interviews result in diatribes more appropriate for a policy or ethical debate. Although it is reasonable to share one's beliefs with a religious or political media agency, when offering background for a basic news story, it is prudent to explain positions on all sides of the debate. Regardless of the forum, the audience must know where objectivity ends and subjectivity begins.

Clarity. The common admonition to speakers to "know your audience" is particularly true for media interviews. There are two aspects to knowing your audience, and they are in some degree of tension. First, speak at a level appropriate to the listener or reader, which, for a general American audience, is routinely considered to be around eighth- or ninth-grade reading level. But at the same time, it is important to respect the audience. Condescension is identified quickly and will undermine the most informative interview.

Empathy. There are few emotional aspects to much medical news --"Secondhand smoke exacerbates lung disease," "New radiological technique detects early breast cancer," or "New vaccine effective against malaria" -- unless reporters personalize them by featuring actual patients.

It is with "breaking news" -- for example, a chemical spill or flood that breaches the local water supply or an outbreak of an undisclosed infection in an elementary school -- that physicians must be cautious. In these situations, the public turns to the media not only for factual details but also for advice on how to respond -- how worried or concerned to be, what precautions to take. Providing accurate commentary in a breaking situation can be challenging, but displaying concern and compassion while responsibly analyzing a situation is what physicians do daily. They are trained to be calm and composed under intense pressure. This skill is vital in media interviews during and following catastrophes.

Confidentiality. For physicians providing care to newsworthy individuals, confidentiality is of critical concern. In these cases, physicians typically cede interaction with the media to a spokesperson representing the patient, the hospital, or both. While this is the most desirable course of action, attending physicians often participate in press conferences, frequently in an attempt to control rumors or calm an apprehensive and curious public.

Preparation is the key to a successful press conference; the goal is to inform without breaching confidentiality or exceeding one's area of expertise. Be it the separation of conjoined twins, the delivery of quintuplets or the status of a political figure following an accident, the public's right to know is always trumped by patient confidentiality. The Hippocratic Oath exhorts physicians to do as much.

Physicians enjoy a reputation for integrity and for advocacy of the public health. By leveraging this hard-earned status, doctors can advance the public good by providing credible, responsible, and informative interviews. That is always newsworthy.

Edward Dominguez, MD, partner and founder of East Texas Infectious Disease Consultants (ETIDC), PLLC, in Tyler, Texas; medical correspondent KLTV-ABC in Tyler and KEZO-FM in Omaha, Neb.