COVER STORY
Physicians and the press

Do doctors get a fair shake?

Our analysis of 12 major newspapers and TV news broadcasts shows a pretty balanced picture—but some outlets are more balanced than others.

By Ken Terry
Senior Editor

American physicians have been neither accurately nor fairly portrayed by the national media. We're presented either as dunderheads who missed an easily diagnosable condition or as gluttons of wealth and privilege," says internist and emergency physician Robert C. Maglio of Perrysburg, OH.

Robert S. Mirsky, an internist from Holland, PA, is just as cynical about the local media. "In the Philadelphia regional media, we've become the new bad guys—corrupt and incompetent—and the public protectors are the lawyers."

Those are the opinions of two of the readers who responded to a recent Medical Economics poll on what physicians think about their treatment by the news media. Sixty-four percent of respondents think the media are totally biased against physicians, and 32 percent say coverage of doctors is more negative than positive.

Do the media really have it in for doctors? To test that hypothesis, Medical Economics looked at nine leading daily newspapers and the three major TV networks' news programs (see "How media coverage stacks up") over a 10-week period. Of the stories involving physicians, we found that a majority were neutral, but that negative pieces outnumbered positive ones in the print media, while the opposite was true on television.

A 10-week survey is by no means conclusive—and ours included neither local broadcast media nor smaller newspapers. However, our results suggest that the media may not be as biased as physicians think.

So why do doctors feel they're being unfairly targeted? One reason is that the tone of the media has changed over the past few decades. While physicians are still among the best-respected professionals, say editors, they now tend to be viewed as ordinary people, with ordinary faults and foibles. "That's probably happened to a number of professions over the years," says Dennis Kelly, a senior assignment editor at USA TODAY. "We've become a little more skeptical of their motives."

Physicians are also under increasing scrutiny because health reporters have grown more knowledgeable about the business of medicine, says Diane Lore, medical and religion editor for The Atlanta Journal-Constitution. "Traditionally, health reporters relied on features and did a lot of human-interest pieces—which is where I think TV coverage is right now. But as people learned about HMOs and insurance and how the money process works, they began to ask a lot of sophisticated questions that doctors don't like."

The ongoing turmoil in the health care system has also focused attention on some negative stories about physicians. For instance, the news media would have reported, in any era, the tale of a Boston orthopedic surgeon who strolled out of the OR to go to the bank while his anesthetized patient lay on the operating table. But amid all the hoopla about medical errors, "there was a huge amount of interest in what this doctor had done," says Scott Allen, health and science editor at The Boston Globe. Even though this was a lapse in judgment, rather than a medical error, it got more play because of the public interest in the alleged horrors of hospitalization, says Allen.

Another issue that has made doctors look bad is the cozy relationship between some physicians and pharmaceutical firms. "We've had big scandals here with the Lahey Clinic and other groups, where the drug companies are giving things to doctors in exchange for getting prescriptions of brand-name drugs," says Allen. "And when doctors see stories about that, they cringe."

Has managed care dragged doctors down?

Nearly half of our poll respondents believe that, when the media cover managed care, physicians come off poorly. Only 17 percent think managed care stories show doctors in a positive light; 35 percent say the coverage is neutral.

But newspaper editors contend that most articles on managed care portray doctors as victims of the system who are trying to do their best for patients. "They're seen as fighters for patients' rights when they go to bat for the patient against the insurance company," says The Atlanta Journal-Constitution's Diane Lore.

In fact, the backlash against managed care has scored some points for doctors, says Ivan Oransky, an adjunct professor of journalism at New York University. This is not only because many physicians have long opposed managed care, he says, but because they have access to patients who can provide the horror stories that editors long for.

Back in the '90s, during the heyday of HMOs, newspapers ran stories about doctors getting bonuses in exchange for limiting care. "That put doctors in a negative light," says Lore. But the issues of capitation and the incentives it creates are too complex for most consumers to understand, notes Andrew Holtz, president of the Association of Health Care Journalists and a former CNN medical correspondent.

The same is true of the medical errors controversy. The medical establishment may have labored mightily to get the word out that the bulk of errors results from systemic problems, but it's the stories about shocking mistakes by doctors that are much easier for readers and viewers to grasp. So articles about wrong-site surgery or the transplant tragedy at Duke University Hospital get vastly more play than investigative pieces about what's being done to reduce medical errors since the Institute of Medicine issued its famous report in 1999.

There's also a key difference between the print and broadcast media. For a story to make it on television, it must be visual. "The broadcast media have a harder time with policy or legislative stories," says Stoltz of The Washington Post. "Unless doctors are shaking signs in front of the Capitol, it's hard for television to cover tort reform, which we do cover."

Now that doctors are shaking signs in front of state capitols, the malpractice/tort reform story is receiving widespread coverage in both print and broadcast media. Coverage during our monitoring period was either neutral or sympathetic to doctors. Holtz believes that reporters saw the story as a struggle between physicians and insurance companies, which have a negative image among consumers. Even though that's not the key issue, it made it easy for consumers to identify with physicians.

Lore agrees that readers could relate to the story on a human level. "People understand that doctors have to make a living, too," she says. But the reason why it transcended the complexities of tort reform, she says, is that it was a story most reporters could grasp. "You have various levels of reporter skill. Malpractice is something they can understand better than, say, Medicare or Medicaid cuts."

"Bad doctor" stories, with their identifiable villains and victims, are also relatively easy to write. But Holtz doesn't regard these stories as evidence of a bias against physicians. "They're like stories about a politician who gets caught breaking a campaign finance law, or a banker who gets caught embezzling. It's the case of an individual who's caught doing something wrong, and I don't know that it reflects on attitudes toward physicians as a whole."

The "greed" factor is hard to combat

Editors say the media still treat physicians with more respect than most other professionals, but doctors don't see it that way. To our poll respondents, the media regard physicians as greedy—motivated by a desire to maintain their incomes and stave off malpractice suits. Only a quarter of respondents say the media believe that doctors are motivated by a concern for patient welfare.

This perception isn't groundless. Like the general public, many journalists tend to view doctors as wealthy people who ride around in fancy cars. They tend to dismiss physicians' complaints that they're losing money under managed care and government programs. "Most people make less than doctors, and it's hard for them to sympathize with someone who's making 'only' $175,000 a year instead of $225,000," notes Stoltz.

The increasing number of physicians who've resigned from health plans and set up "boutique" or "concierge" practices fuels impressions that money is a doctor's top priority. To reporters and readers, says Scott Allen of The Boston Globe, "concierge medicine looks like a doctor has decided to cater just to affluent patients. It makes the doctor look like a greedy person who's excluding lots of patients because they can't afford it." It isn't recognized as a justified protest against managed care.

The doctor and the priest suffer for their images

With the post-Watergate rise of investigative journalism, reporters became more skeptical of everyone, notes Ivan Oransky of NYU. But when they saw doctors doing questionable things to enhance their incomes, he says, journalists were often more critical of them than of other businesspeople. Examples include stories about physicians accepting favors from drug reps and referring patients to labs they own part of. "Doctors are held to a higher standard when it comes to their business practices," he notes.

In this regard, he suggests, physicians are a bit like priests, whose image has been hurt by the sex abuse scandals in the Catholic Church. "If you're covering politics, you almost expect to be deceived," says Oransky. "It's not a big deal when a politician does something ethically improper. But when a doctor or a priest does the same thing, boy, is that a problem."

Journalists haven't lost all their reverence for the medical profession, however. That was clear in the laudatory pieces about Sen. Majority Leader Bill Frist, a Tennessee Republican and heart surgeon, helping accident victims in Florida. USA TODAY recently ran a story about a Mississippi doctor who's on the front line of fighting diabetes. Similar pieces appear all the time, say editors, yet doctors hardly seem to notice.

This may be because physicians feel they're being blamed for many problems that are beyond their control. "They're involved in some very pressing, unresolved issues," says The Boston Globe's Allen. "The system is in upheaval, and there's a lot of mud flying around—some deserved, some not."

How media coverage stacks up

By Deanna Othman

Physicians are depicted more negatively in print than on television, according to our 10-week analysis of coverage in nine major newspapers and on the evening news shows of the three leading television networks. But the vast majority of the 183 stories surveyed in both media had a neutral viewpoint.

We rated stories by subject matter, approach, or both. For example, we gave a positive rating to a story in the Feb. 25 edition of The Dallas Morning News that showed how doctors work apparent miracles by performing organ transplants. We negatively rated a Feb. 10 piece in The New York Times that found that some doctors who do surgical procedures lack experience with them. A Jan. 3 Chicago Tribune article on doctors protesting the rising costs of malpractice insurance got a neutral rating.

The study spanned the period from Dec. 18, 2002 to Feb. 27, 2003. During that time, the average newspaper or TV news show had 2.8 positive pieces, 4.1 negative ones, and 8.3 neutral ones.

We applied a point system to weight the ratings based on the circulation or viewership of each newspaper or TV show. Neutral stories remained dominant in the weighted tally, but total positive points (209) outscored negative ones (156). That's because of the huge viewership of the TV networks.

The bottom line

What doctors have to say about their media image

By Sheetal Nasta

Internist Richard E. Waltman often notices headlines in the women's magazines that lie around his waiting room. Among the ones that have troubled him are "20 things your doctor doesn't want you to know" and "How to tell if your doctor is incompetent."

Waltman, who practices in Tacoma, WA, doesn't think the media have a vendetta against doctors. But many of his colleagues do. As the accompanying story explains, almost two-thirds of the doctors who responded to our recent poll believe that the media are biased against physicians.

The image created for physicians by such TV doctors as Marcus Welby may be unrealistic, but today's stories—about malpractice suits, incompetence, and greed—swing too far the other way, doctors told us. "It's a sign of our times. Everyone is skeptical of authority figures," says internist Paul M. Reinbold of Cambridge, MD.

Internist Catherine R. Landers from Skokie, IL, says the rise of managed care "has pitted patients against their physicians," and that the media have widened the schism with inflammatory coverage.

"The media don't pay any attention to the altruistic aspect of medicine," says Reinbold. "It's almost like an establishment-bashing mentality. Physicians are vulnerable today because they used to be affluent and respected."

But what some call doctor-bashing, others consider to be healthy skepticism. According to Gil Solomon, an FP in West Hills, CA, the new kind of journalism tends to produce more-balanced coverage.

"Physicians are getting more negative articles written about them, but so is everyone else," says Solomon. "Thirty years ago, the media probably wouldn't have gotten all the details or questioned the doctor's opinion. They just would have accepted it. Now they get counterarguments."

Waltman also finds recent coverage of events such as Duke University Hospital's transplant disaster to be fair. "Back in the old days, you didn't know much about doctors. There was a code that you didn't say bad things about people in the public eye. After Watergate, there seems to be this obligation to tell the dirt on everybody."

But he also finds a significant level of misunderstanding. "People don't know how incredibly terrible it is to have patients die, or how terrible it feels to make a mistake," Waltman says. "We need to let people know some of the realities."

Ken Terry. Physicians and the press: Do doctors get a fair shake?.

Medical Economics

Jul. 11, 2003;80:78.