How the Popular Press Affects Patient Expectations

Wondering how your patients see your work as a physician? Just open a newspaper, turn on TV news, or go online to see how you are being portrayed.

What, and how, the popular media reports on medicine and healthcare can have a profound effect on patient perceptions, attitudes, and expectations.

When I studied journalism and then worked as a reporter - back in the age of using film for television field reports and linotype in newspapers - I was taught that objectivity was the absolute highest responsibility of the media when reporting hard news. The rules were linear and unqualified: who, what, when, where, why, how, and how much. Start with the most important, and end with the least.

The rules were, and still are, intended to manage bias and keep personal opinions just that. We called it journalistic integrity.

But then, as now, such high ideals were often deliberately compromised to satisfy the political or powerful, and more often, subconsciously reflected personal biases. Facts may be facts, but choosing which ones to include and exclude given space limitations is a highly subjective process.

How news is delivered has changed a lot since then. There is the Internet and cable news, both with 24/7 instantaneous reporting, newspapers and magazines struggle to remain in business with strong motivations to remain relevant and to push sales, and there are lots of bloggers, many of whom have become, in many ways, more influential than print journalists. Where we get our news has also changed depending on age.

Because it is often difficult to separate news from editorial regardless of the medium, even with the mainstream media, it is surprisingly easy to manipulate what people take away from a story by selectively reporting facts, sensationalizing it, or not covering something at all. Quoting out of context to make a point has become an art form.

For example: On September 6, 2012, the Institute of Medicine of the National Academies, a highly respected, non-profit group that works outside of government, reported their findings on an extensive 2009 study indicating that some $750 billion annually (more than one third of all healthcare expenditures in 2009 dollars and 30 percent in today’s dollars) is “wasted.” After 18 months of work, the report identified six primary areas: unnecessary services ($210 billion); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion). After considering overlap, the panel settled on an estimate of $750 billion per year.

The report was widely covered, but the takeaways were considerably different, despite each stating the “facts.”

ABC News, with the headline, “US Health Care System ‘Wasted’ $750 Billion in 2009,” laid the responsibility squarely on the healthcare system saying, “The report, released today by the Institute of Medicine, suggested the money squandered on services that failed to improve Americans’ health could have provided health insurance for more than 150 million workers or covered the salaries of all of the nation’s first responders for more than 12 years.” It also mentioned how the Affordable Care Act addressed the issue by with its medical loss ratio provision limiting insurers’ administrative costs and profits.

FOX News, with the headline, “Report: US health care system wastes $750 billion a year,” tied the report to the presidential campaign, saying, “President Barack Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk. But the counter-intuitive finding from the report is that deep cuts are possible without rationing, and a leaner system may even produce better quality.” They went on to cite ten recommendations in the report to address the situation.

USA Today summed it up in 80 words about the system’s failures.

The Atlanticpegged responsibility to healthcare providers, saying, “By far the biggest black hole when it comes to waste has to do with how we practice medicine - over half of it is accounted for by unnecessary services, inefficient care, or the failure to prevent problems that require expensive intervention.”

Why do these changes often make practicing medicine and providing clinical services more difficult? In three of these four top Google ranked articles, it would be reasonable for a lay person to conclude that you are incompetent, greedy, and perpetrating fraud.

Find out more about James Doulgeris and our other Practice Notes bloggers.