Braving the media

Dealing with the media can be an interesting sideline or a career-threatening intrusion. Jonathan Haslam looks at the pitfalls and rewards

It often seems that the more negative the story, the more likely it is to receive the media's attention

The mainstream media love a medical story. Whether it be a medical advance that they can trumpet as a miracle cure or a case of alleged medical negligence, they seem to have an insatiable appetite for all things health-related. When it comes to stories about individual doctors and the medical profession as a whole, however, the media does seem to prefer to cover negative stories. In fact, it often seems that the more negative the story, the more likely it is to receive their attention.

This may or may not be true, but it is certainly how UK MPS members who participated in a poll last July view things. Of the 640 respondents, 72.4% described press coverage of the medical profession as either negative or very negative.

And they are not the only ones to have this perception: doctors all over the world are expressing concern about the bad press the medical profession seems to attract. There is some, but not much, hard evidence to support this view. In 2006, for example, a review of Australian newspaper articles about the emergency department found that 45% of stories were negative; 15% were positive and the rest neutral.¹ These findings are hardly surprising – “doctor harms patient” is akin to “man bites dog” in the world of journalism which, when you think about it, is quite heartening for the profession (if uncomfortable for the individual doctors concerned). It means that “rogue doctors” and “blundering medics” are still enough of a rarity to be considered newsworthy.

Perhaps surprisingly, negative media coverage of doctors, either of the “blundering doctor” or the self-interested “old boys’ club” variety, does not appear (in the UK at least) to adversely influence trust in doctors. The BMA has been commissioning MORI polls since the 1980s that show “ongoing trust and belief in medical competence, with little deviation even at times of highly adverse publicity”.²

There does seem, however, to be a mis-match between the public’s beliefs about the healthcare system as a whole and their direct experience of it – what Nigel Edwards of the NHS Confederation terms “the perception gap”. His 2006 report contains an interesting pair of histograms based on a MORI survey. One shows that 73% of respondents think medical professionals are a reliable source of information, whereas only 34% place reliance on the national press. The other histogram shows respondents’ perceptions of how favourable to the NHS different sources of information are: 70% think the national press is critical of the NHS and, interestingly, only 38% think medical professionals are favourable towards it.³ Maybe health professionals can sometimes be their own worst enemies.

There are many ways in which doctors can become involved with the media; they can be pundits, advisers, commentators, participants in documentaries, consultants for dramas and soaps and so on. Most of these can prove satisfying and sometimes lucrative, but even in this capacity doctors need to be wary. The respondents to our survey had mixed experiences to report (see Box 1). Many respondents to our survey expressed profound distrust of the media generally (See Box 2), but it is reassuring to find that those who have had dealings with them were more positive; less than a quarter – 22.1% – felt that their experience with the media was negative.

Enquiries about cases and patients

More than one in seven of the doctors in our survey had been approached by the media about a patient in the last five years. The professional duty of confidentiality puts a doctor in a difficult position when a patient goes to the press. No matter what the patient has placed in the public arena, the doctor must respect the patient’s confidentiality. To do otherwise risks disciplinary action and regulatory sanction.

As part of the revision of its guidance on confidentiality, the GMC has issued draft guidance on responding to press enquiries (see Box 3). This guidance is clear that you should not divulge confidential information without the express consent of the patient. Doctors in our survey were supportive of this principle. Only 7.7% felt that, if a patient discloses confidential information about themselves, they forfeit any right to patient confidentiality. As one doctor commented, “Even if a patient discloses information about themselves to the press, doctors are still bound by rules of confidentiality regarding other privileged information. This therefore puts doctors at an unfair disadvantage when correcting inaccuracies and challenging or responding to allegations.” Most requests for information (67% in our survey) come over the phone.

So how should you respond when a journalist is pressing you for an answer about a patient? The first step is to take a deep breath. Before you say anything, get the following information from the journalist:

Name
Name of the publication
What, exactly, they want you to comment on
Their deadline
Who else they have spoken to
Their number, so that you can ring them back.

You can then take time to gather your thoughts and formulate a response. Always take advice. Almost 60% of doctors in our survey did, whether with a call to MPS or, more usually, their NHS trust. In general the advice that doctors received was rated highly (88% rated it good or very good) so seeking professional advice is worthwhile. When you formulate your response, take advice, stay calm and professional and always keep patient confidentiality in mind.

Doorstepping

Behave calmly and professionally – you do not want to be seen as defensive or hostile

Occasionally the media will come straight to your door, whether at home or at work, which can be an unnerving experience. If the journalist brings a photographer it can be even more intimidating. Thankfully it is rare – in our survey only one in five enquiries took such a personal approach. Again, behave calmly and professionally – you do not want to be seen as defensive or hostile. Ask them for their contact details so that you can get back to them. The traditional response of “no comment” now looks defensive and hostile. Instead, try to give a measured response that is composed and professional. “I am sorry but I am not able to answer your questions right now, but if you give me your contact details, either I or my trust’s press office will get back to you.”

More than 80% of the doctors in our survey would not let a photographer take a picture of them. However, our advice is that photographers will take your picture regardless, so let them. Try to look calm and confident, but be careful about smiling, which can give the wrong impression.

Media stars

In our survey, doctors were much more likely to have been asked to write an article than to be asked about a particular patient. This can be the positive side of the media, an opportunity to get your knowledge and opinions across. However, remember that there are still risks, and if you fall foul of them, these can affect your medical career:

Plagiarism – Ensure that you reference the work of others as appropriate.
Copyright – Make sure that you have the rights to reproduce any material you want to re-use.
Consent – Follow the guidelines of the GMC on using information about patients.
Libel – Avoid making untrue or disparaging comments about individuals or companies.
Unprofessional comments – be wary about your subject matter. Comments that are racist, sexist or homophobic may be considered unprofessional by regulators.

If you are asked to write an article, make sure that you have all the details before you begin:

Don’t commit yourself until you are happy with the commission and what it entails.
Negotiate a deadline that suits you.
Insist on seeing the edited copy before publication.
Clarify copyright arrangements for the work with your publisher.
Seek advice before signing any contract.

If it all goes wrong

Unfortunately, if the story casts you in an unfavourable light, but is factually correct, there is little that can be done

Finally, there are the rare, dreaded occasions when you read something scurrilous about yourself. How should you respond? Most doctors in our survey (63%) said that they would contact MPS first. MPS can offer objective, professional advice. The press office can talk you through your options. Unfortunately, if the story casts you in an unfavourable light, but is factually correct, there is little that can be done. Libel claims are expensive for publications, so writers and editors are well trained in producing copy that is within the law.

Careful use of language can appear sensational, while staying within the facts. For example, “Doctor faces dismissal” means that the doctor could be dismissed, but implies that he will be. If there are errors of fact, then the publisher can be asked to print an apology. If the errors are more serious, then it may be necessary to begin a defamation case. These are expensive, but if you believe you have been defamed then you should contact MPS for advice.

MPS may be able to assist if a defamation action is brought against you, in matters arising from your professional practice. Always make sure you check any contract for indemnity clauses and seek advice before signing it.

Conclusion

While the media can be hostile at times, most dealings that doctors have with the press are positive. Following some of the ground rules set out in this article can help the experience be less intimidating.

Box 1: Mixed experiences reported by survey respondents

Most approaches from the media have been for background information. For example, there has been a high-profile case about an anorexic patient and the media say ‘Please explain to our viewers what anorexia is. How common is it? What are the warning signs?’ etc. They always seem to understand when I explain that I cannot comment on the case in question.”
“‘The media’ is a broad term that spans a spectrum from excellent, well-informed, intelligent journalism to purveyors of purulent lies. I do not imagine that even the most careful medic can guarantee to prevent accidents if tricked into dealing with the latter. The former are a pleasure to deal with.”
“I watched as a colleague was torn to shreds in the media recently and he was always mis-quoted. I … gave them the evidence base – they chose to ignore this and yet he had no power of comeback – outrageous!”
“I have had extensive media involvement, all of which has been appropriate, straightforward and by-and-large honest. There are good journalists out there and we need to be able to engage with them without a shield of lawyers and obfuscation.”
“At the time of publishing a research article in a peer review journal I was contacted by local and national radio stations for interviews. It was obvious that they wanted to put a more sensational spin on the findings and a sound bite was valued over a balanced and accurate presentation of the findings.

Box 2: Expessions of mistrust from survey respondents

“So often with the media they are just in search of quick, attention-grabbing headlines at any cost.”
“I hope I can keep out of the press at all costs. Even if it was because of a feat of exceptional service, one can always be guaranteed there is some journo somewhere who would like to take another deranged view of your actions to make a story out of it.”
“I would be worried having any dealing with the press as clearly they bend what you say and often misrepresent what was said.”
“Don't trust anybody in the media. The media are never your friend.”
“[The media are] generally looking for an angle to run a story. They’re not necessarily interested in the truth – just want a good story. They can be helpful, but a degree of watchfulness is required in any dealings with them.”

Box 3: Draft GMC guidance on responding to criticism in the press

Doctors are sometimes criticised in the press by their patients* or by someone their patients have a close personal relationship with. The criticism can include inaccurate or misleading details of the doctor’s diagnosis, treatment or behaviour. Although this can be frustrating or distressing, it does not relieve you of your duty to respect your patient’s confidentiality. Disclosures of patient information without consent can undermine the public’s trust in the profession as well as your patient’s trust in you. You must not put information you have learned in confidence about a patient in the public domain without that patient’s express consent.

… You may disclose information to your own legal adviser if that is necessary to prepare a defence, take legal action against another party or otherwise take their advice where the legal adviser is bound by legal professional privilege. You should seek advice from your professional or defence body or from a solicitor on how to respond to press criticism and, if appropriate, any legal redress available to you.

*In this guidance, “patient” is used to refer to both current and former patients. The full draft can be accessed via the GMC’s website – www.gmc-uk.org

References

1. Kennedy J, Trethewy C, Anderson K, Content Analysis of Australian Newspaper Portrayals of Emergency Medicine, Emerg Med Austalas, 18(2):118–24 (2006)
2. Ford, J, Public Trust in Doctors Undented (Letter), BMJ 335: 465 (2007).
3. Edwards, E Lost in Translation: Why Are Patients More Satisfied with the NHS than the Public? The NHS Confederation, London (2006), p. 8.