The Challenges and Opportunities of Physicians Engaging Mass Media

The first patient to die while under my care passed away on a cold November morning in Philadelphia. He was twenty-five and had liver failure from severe alcohol use disorder. By the end, his skin was such a deep yellow that it had a greenish tint. During the last night of his life, we used a long needle to pull three liters of a frothy, cola-colored fluid that was causing his abdomen to swell so much his skin cracked. His mom was there, by his bedside, as she had been the entire two weeks that I knew him.

Liver failure, I came to realize intimately, is a horrible way to die.

As is typical in a teaching hospital, after our morning rounds, we received a lecture from a senior doctor. In a completely off hand way, he mentioned that women wait longer than men for liver transplants. Seeing how terrible it was to die of liver failure, this was rather disturbing to me. I followed up with him and poked around the scientific literature. I found that women wait longer for transplants across all major organs. I interviewed a female transplant surgeon at my institution who has published on such disparities for the academic press. I found a woman in California whose wait for a life-saving lung transplant was already five-times longer than that of the average male. I eventually wrote a reported piece on gender disparity in organ transplant that was published in an online news site. This publication was a result of my experience in patient care and my access to scientific research. In other words, my day job as a medical student allowed me to share the reality of gender disparities with the general public.

I share this story to launch a discussion of some of the opportunities and challenges of physicians engaging mass media, fitting the 2019 Milton Wolf Seminar discussions of the struggles and solutions to the new global media (dis)order. What are the strengths and pitfalls of physicians taking what they see in their day jobs and turning it into pieces of writing for the lay public?

In terms of opportunities, physicians have a front row seat to the good, the bad, and the ugly of healthcare. In journalistic terms, we have access. I keep a running list of article ideas based on things I’ve seen in the hospital that make me go, “Wait…What?!” Many of the issues our patients face highlight systemic flaws in healthcare. When we share the stories of our patients, we can shed light on the often-Byzantine healthcare system. Many of our patients’ stories are also deeply touching, offering emotional valence to a field that can otherwise be bone dry. For example, a story about a daughter trying to provide the best care possible for an elderly mother at the end of life could be a compelling launching point for a discussion for the misaligned incentives and negative externalities of reimbursement models. This notion is consistent with a presenter’s proposed solution to media disorder during the Wolf Seminar when s/he said, “The best defense against fake news is to develop your own strong narratives.”

Another advantage of physicians engaging the mass media is that it can ameliorate economic pressures on the media. As was discussed during the seminar, many traditional news outlets are losing their ability to compete economically with social media. Social media is fraught with misinformation and without the ballast of traditional media, “viral deception” can fester. Traditional news outlets are cutting staff, which leaves journalists with less time to report important stories. This problem is particularly severe in the United States, where, we learned in the seminar, the public funding for media is paltry compared with other developed nations. As a physician-writer, I don’t have to earn my living by writing. Easing the financial pressure means I can spend longer on a story than a traditional journalist. While this model may be dismissed as volunteerism, it actually carries a strong tradition within medicine. For decades, physician-scientists have been employing a similar arrangement to fund their research time with universities. Academic physicians could then be encouraged to engage the popular media within existing physician salary structures.

The last opportunity of physicians engaging the popular media is that of trust. While public belief in expert opinion appears to be on the decline, there is still a good amount of trust in the training and authority of physicians. This trust stands in contrast to mainstream media, which is seen as increasingly biased. The public demands right-from-the-source coverage that physicians can provide. Sharing stories from the front lines of healthcare fits new trends in global media, with “authenticity,” as one Milton Wolf presenter noted, becoming the “new truth.” Of course, with this trust comes responsibility—which is why the pitfalls of physicians engaging the popular press must be carefully examined.

In terms of challenges, the first and most significant is ethical. While the Wolf Seminar focused on the tension between the freedom to lie and the right to truth, in medicine there are ethical constraints to telling the truth with the public. The doctor-patient relationship is a personal, not a public, one. Especially in the psychiatric world where I will be practicing, patient confidentiality is paramount. If a patient Googles my name and sees that I share patient stories with the reading public, will she or he trust me completely? Even a kernel of doubt or mistrust could be compromising. How do I get consent from patients to write about them in a way that doesn’t cheapen the doctor-patient relationship? One of the main themes from the seminar was how, in the changing media landscape, the poor and disfranchised are the most likely to be harmed by the changing media landscape. This theory holds true with physician-writers, as coercion is a far greater risk when consenting to share the stories of patients with lower socioeconomic status. As with so many other areas within the changing landscape of the media, the ethics of physicians engaging mass media demands serious attention.

The second challenge involves career advancement. In academic medicine, writing for the popular press carries no weight for promotion. The only writing that is counted is that which is done for the peer reviewed literature. This means that physician-writers also have to be producing research in addition to writing for the popular press, which stresses already limited time. Surely there is room within evaluation schemes to value contributions to the popular press, but from what I’ve seen, peer reviewed publications—even if far less influential outlets—is still chief currency of career advancement.  This is a relatively easy problem to solve—tenure committees could simply consider all writings to be submitted for evaluation, but thus far this shift has been slow to come to academic medicine.

The third challenge is self-evident: by nature of the position, physician-writers are not full-time journalists. The types of deep, investigative reporting that are crucial to a functioning democracy and healthcare system are probably out of reach to those with other day jobs. Physicians are trained to analyze scientific literature and bring those findings to an examination of the individual before them. These skills carry similarities to those necessary for journalism, but the overlap is incomplete. Impartiality, for example, is difficult for a physician-writer who is likely a part of a large institution, a professional guild, and a department, each with their own vested interests. As a doctor, I can share what I’m seeing from the front lines of medicine, but the real investigative digging is best left to the pros. I worry that my participation in the media could be a symptom of a casualization of the media that disserves society.

Given the challenges and opportunities outlined above, physicians can play a role in addressing the challenges of the new media landscape. As I shared at the introduction to this post, my work within a hospital allowed me access to a specific gender iniquity in the healthcare system about which I was ultimately able to publish. I hope that I am able to continue such endeavors through my career—though I understand the need for some caution. With trust in media declining and deliberate misinformation spreading, there is more need than ever for subject experts to engage the popular media. Certainly, there are obstacles with this engagement, but the solution should not be for physicians to retreat behind their academic paywalls. Rather, deliberate steps can be taken to allow physician-writers to play a role in taming the new global media disorder.