Reporter examines ethics of interviewing patients

May. 3rd, 2011 by Andrew Van Dam · Leave a Comment
Filed under: Health journalism 

After joining a panel on media, ethics and trauma at the Anxiety Disorders Association of America’s annual conference, New Orleans Times Picayune reporter John Pope found himself questioning the sourcing practices he’d developed and followed during almost 20 years on the health beat.

As he writes for the Dart Center for Journalism & Trauma, he had no idea of the legion of ethical dilemmas each time he, like countless other health journalists around the country, simply called a specialist in a relevant field and asked for help finding patients who would be willing to talk.

At the panel, Pope suddenly found himself confronted with the questions his innocent requests were raising on the other end of the line. I’ve reproduced his list below, as it’s pretty thought-provoking material.

  • Would a therapist be exerting undue influence by asking a patient to speak to a reporter?
  • Would the patient feel obligated to comply as a condition of treatment?
  • If the therapist were present during the interview, would that inhibit the patient?
  • If the therapist weren’t present, would the patient exaggerate to help the reporter get a terrific story?
  • Would talking to a reporter reopen psychic wounds if no professional were on hand to guide the conversation?

They are questions that defy easy answers. Many physicians assembled even said that they viewed allowing a patient to speak to a reporter as “unethical in all circumstances.” Nevertheless, a few folks provided suggestions such as posting solicitations for sources in waiting rooms, thus allowing reporters to bypass the doctor-patient relationship, or perhaps asking physicians to maintain source lists of willing and qualified patients.

Neither seems practical or satisfactory on deadline, and in the end their may really be no solution other than Pope’s own, that physicians and reporters form long-term relationships and build the sort of trust necessary in delicate situations.

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Lack of health literacy can be fatal

Apr. 14th, 2009 by Andrew Van Dam · 1 Comment
Filed under: Hot Health Headline 

Pauline Chen, M.D., wrote in The New York Times about “health literacy,” arguing that both patients and doctors share the responsibility of ensuring that patients truly understand their conditions and the behavior expected to them.

Chen tells the story of one patient, a former professional athlete suffering from diabetes and other chronic ailments, who died after he was discharged from the hospital because he did not take proper care of himself.

Dr. Rebecca L. Sudore, assistant professor of medicine at the University of California, San Francisco, was lead author on a “landmark study that linked limited health literacy to higher mortality rates.”

Dr. Sudore went on to suggest ways in which doctors and patients might address health literacy. “One thing we tell clinicians to do is to ’teach back’ or ’teach to goal.’ A clinician might say, ’I’ve just said a lot of things and I want to make sure I’ve explained things clearly to you. Can you explain things back to me, so I know you understand?’ This discussion creates a kind of a shared understanding. The doctor may not have the time, but these questions can bring up red flags that can be discussed during a follow-up appointment.”

For patients, Dr. Sudore recommended taking the initiative to tell the doctor how much is understood. “You should go back to the doctor and say, ’What I hear you saying is this. Did I get that right?’ Or, ’I’m leaving the hospital. You just gave me this new drug, but I’m still supposed to take all my other medications. Is that right?’ ”

Hear more about the topic at Health Journalism 2009 at the panel “Health literacy: Does the public understand you?“

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Survey finds barriers to shared decision making

Mar. 20th, 2009 by Ed Silverman · Leave a Comment
Filed under: Studies 

Do doctors really want their patients involved in decision making? And even if many do, what are the barriers that prevent such involvement from taking place? Well, a new survey sheds some light on the issue and finds that many doctors would welcome more interaction with their patients when it comes time to make decisions, according to the Foundation for Informed Medical Decision Making.

The survey of 402 primary care physicians found that 93 percent say that the concept of shared decision making sounds like a positive process, and 52 percent described it as a “very” positive process, particularly for tackling lifestyle problems and chronic conditions. In fact, about 80 percent say patients would be “much” more likely to improve in these areas with the technique. But there was slightly less confidence about using the method for reviewing surgery, cancer screening and taking new medications.

There are some important barriers, though, to implementing shared decision making. Time was cited as the largest challenge, followed by the perception that patients do not understand all they need to know and preferring patients rely on physician advice for medical decisions. For example, 82 percent say it is “very” important for patients to be informed about taking new prescription medications, but only 16 percent say most of their patients are well informed in this area.

And 78 percent say recent changes in reimbursement rates have, not surprisingly, decreased the time they can spend with each patient. And 51 percent say they are very concerned, in general, about not having enough time to spend with patients.

Just the same, the foundation believes that, by using shared decision making, physicians and their patients can “determine which choice matches what is most important to patients – delivering high quality care that is both evidence-based and patient-centered.” Here is the white paper with still more interesting insights.

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