A new MD-journalist asks, “Is there a role for the physician-journalist?”

Last week I wrote that NBC News medical contributor Dr. Natalie Azar was placed into a conflict of interest situation when asked to comment on the air about a story concerning Chronic Fatigue Syndrome (also called ME/CFS with a new proposal to call it Systemic Exertion Intolerance Disease).

Dr. Azar delivered her comments after being introduced by NBC anchorman Lester Holt as a rheumatologist who treats this problem. In other words, she was being paid to be a journalist talking about what she was paid to do in her day job.  You can read the full post here.

It wasn’t a loud, screaming conflict.  But it’s the quiet little ones that, perhaps, we should worry about more.

My blog post stirred things up a bit – or “raised the temperature a few degrees,” as recent Harvard Med School grad and aspiring journalist Shara Yurkiewicz put it on Facebook.

A couple of online commenters didn’t see a conflict:  one physician and one TV news guy.

Most commenters on the blog or in social media did see it as a conflict – or saw other problems with Dr. Azar’s appearance:  2 longterm patients and more than a half dozen journalists, including another woman physician who is a major market TV news medical contributor.

But the longest and most thoughtful comment came from the aforementioned Shara Yurkiewicz. You can see her comments on Facebook or in the comments section following my original blog post.  She asked many good questions, to which I’m going to attempt to respond.

Dr. Yurkiewicz wrote: (Dr. Azar’s) obvious conflict is that she benefits from the increased credibility given to CFS as a “disease,” since she can get more referrals. But I also have a difficult time imagining what kind of person should be a medical contributor. It makes sense to me that a person to comment on the study should be someone with expertise and experience in the field. Should she have been replaced by a journalist who doesn’t see patients (but who may still have an agenda)? Should she have been replaced by an internal medicine doctor, who sees CFS but less often? What about a cardiologist, who has no skin in the game?

The others in [Yurkiewicz’s newsroom with whom she was debating this] thought that Azar should be used as a source, not a contributor (though watching this clip, it feels difficult to tell the difference). Apparently it’s “journalism 101.” For me it raises the question, can a practicing physician also be a journalist? If so, should be MD-journalist not report on stories in his/her specialty? Expertise and experience lead to bias, but I wanted to know what the alternative was.

My response:  You’d have a difficult time finding a definitive definition of what a network TV contributor is.  But, based on my experience, here’s my take on the difference between a source and a contributor.  A source has been selected by a journalist to comment on a topic.  He/she is not paid to do so (or if so, we enter an entirely different ethical arena).  A contributor is paid to contribute to the news as an extension of the news team.  That role should carry with it an emphasis on independent vetting of claims and evidence, rather than offering personal or professional opinion.

But, in effect, Dr. Azar appears as a source (someone offering her own opinion), yet she is referred to as an NBC News contributor, and she sits across the anchor desk and has an NBC graphic with her name and the peacock superimposed.

I’m not aware of any other member of the news team being introduced as one who makes a living doing something else, and then “reporting” on that other occupation.

The Society of Professional Journalists code of ethics states: “Journalists should avoid conflicts of interest, real or perceived.”

I agree with your co-workers about possibly using Dr. Azar as a source, but not as a contributor.

However, even using her as a source raises all sorts of other questions.

  • Why would she be the best source for a national TV network to turn to on this topic? Is she the best source to discuss treatment of chronic fatigue – or is she simply available?
  • Is it simply because she’s a rheumatologist and she’s in New York?  Clearly, NBC can pull in experts from anywhere in the country to be interviewed by their bureaus or by local affiliates.
  • But this gets at one of the reasons why someone like Dr. Azar is used as a contributor, not as a source.  She’s an MD.  The networks must have some audience research that suggests viewers like seeing MDs on the air.  She’s done TV elsewhere. She’s telegenic – something we really don’t care about in our sources/interviewees – but a key attribute news managers strive for in people who sit at the anchor desk.  And she’s in New York – where the Nightly News studio is located.
  • I live in fly-over country in the Midwest.  It’s interesting to note that no health/medical experts in the Midwest are currently used as network TV MD-journalists or contributors. Are there no health care experts in the Midwest?
  • Regarding her expertise, some of the patients who reacted online to Dr. Azar’s on-air comments wrote that her comments on exercise for the condition were wrong. She said, “exercise can be very beneficial.”  Indeed, NBC has now published an editor’s note online, reading, in part: “The Institute of Medicine says some forms of exercise, while beneficial for some patients, are not recommended for a significant number of patients suffering from this condition, and in some cases can exacerbate symptoms.”  There was no hint of that in Dr. Azar’s on-air comments.

Can a practicing physician also be a journalist?

Should an MD-journalist not report on stories in his/her specialty?

What’s the alternative to the bias that comes with expertise and experience?

Yes, I think a practicing physician can also be a journalist.  I also think it’s possible for him/her to report on stories in his/her specialty.  The alternative – the approach that I would recommend – has several components:

  • For the network, avoid the conflict by turning to another type of MD contributor – if, indeed, you think it’s critical to have an MD contributor in the studio.  Let it be someone with an independent perspective.  For example, an internal medicine physician doesn’t have the same conflict as a rheumatologist in this case, yet can speak to the primary care provider’s perspective with this condition.
  • Manage the conflict – real or perceived – more openly and directly.  Be far more transparent about what it means to be a physician reporting on things you do in your day job.
  • As the SPJ code of ethics also states, “Label advocacy and commentary.”  So, in this case, it would be far better to acknowledge, “Now, I’m a rheumatologist and part of my income comes from treating such patients.  And different doctors may think differently about this, but here’s my opinion……”  Even then, this is far from ideal.
The Association of Health Care Journalists Statement of Principles, written to build on the SPJ code of ethics and other such valuable codes, was also written to address some of the issues that arise specifically in the coverage of health care news.  It has several relevant clauses:
    • Be vigilant in selecting sources, asking about, weighing and disclosing relevant financial, advocacy, personal or other interests of those we interview as a routine part of story research and interviews. (Note:  this is about selecting sources, much less how it applies to the individual delivering the news who has such conflicts!) 
    • Distinguish between advocacy and reporting. There are many sides in a health care story. It is not the job of the journalist to take sides, but to present an accurate, balanced and complete report.
    • Avoid any personal or financial interest in any field related to what is being covered.

Dr. Yurkiewicz wrote: The others (with whom Dr. Yurkiewicz debated in her newsroom) said that it was insulting to journalists to assume that they have less expertise than an MD in this role. It’s what they’re trained to do. But in turn, I wondered, isn’t it insulting to the physician to assume that he or she cannot possibly present information fairly? 

My response: Let me suggest that we put aside what might be insulting – to anyone.  Journalism’s credibility – and the integrity of the information – is what’s at stake. That’s why journalism codes of ethics emphasize the phrase about avoiding conflicts real or perceived.  A perceived conflict is one in which an individual’s words or actions could appear – to a reasonable person – to be biased because of a financial interest or professional activities.  Perception is in the eye of the beholder.  Read the comments that I mentioned above about some viewers’ reactions to the NBC piece in question.

So I would set aside discussion of who might be insulted concerning judgments about expertise, and rather, be open-minded enough to understand how very real is the perception of conflict in such situations.

Dr. Yurkiewicz wrote: I report on medical education. I am also in medical education (as a past student and future resident). I’ve felt that my background gives me good context to ask relevant questions when I’m reporting a story. I acknowledge that I’m biased. But I can’t get away from the idea that expertise leads to bias, whether you’re a journalist or a physician. So… is there a role for the physician-journalist?

My response: You’re asking the right questions. There are often no clearcut right and wrong answers in ethical decision-making.  But there can be processes we can employ to think about potential conflicts and to manage or avoid them.  The only way we get there is by talking about it.   Posting a journalism code of ethics on a newsroom wall doesn’t do much if the content of the code doesn’t become part of the daily decision-making in that newsroom.  It’s clear you’ve already started newsroom discussions.

I taught a media ethics class for 9 years in the University of Minnesota School of Journalism & Mass Communication.  I still hear from some of those students now that they’ve advanced to their professional careers.  I doubt that most physician-journalists – at least the ones who are elevated to almost celebrity TV-doc status – even have that level of basic undergrad grounding in journalism ethics.

I think there can be a role for the physician-journalist, but it’s as a journalist who happens to be a physician, not as a journalist because he or she is a physician.  That’s what probably rankles your newsroom colleagues.  The knowledge, education and experience of a physician can – potentially – be very helpful.  But, as you point out, it can also be biasing.  I’ll call that potentially harmful.

Perhaps the single biggest problem with MD-journalists/contributors wearing two hats is that they forget which one they’re wearing.  When wearing the journalist hat, it’s not the time for advocacy and opinion. It’s not the time to inject advice.  It’s not the time to be “one of the medical gang,” worrying about how your health care colleagues will react to what you write or say.  When wearing the journalist hat, it’s time to, as SPJ says – “be accurate, fair, thorough, honest and courageous in gathering, reporting and interpreting information…to take special care not to misrepresent or oversimplify in promoting or summarizing a story.”

Someone has to remind MD-journalists/contributors that as journalists – as contributors to the news effort –  their role is reporting the news, not being the news. Does anyone in TV network news management remind them of this?

Remember what Upton Sinclair wrote:  “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

It may be difficult for a physician who is given a chance to be a TV star to understand that being a physician-journalist-contributor carries special ethical responsibility, when his/her salary (in medicine and in television) depends on not understanding it.

It may be difficult for the TV networks – or for local TV stations or any news manager hiring a physician as journalist/contributor – to grasp the ethical conflict if they put a higher premium on ratings and ad revenue and their own salaries than on accurate, balanced, complete health care news and information.

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Comments (4)

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Shara Yurkiewicz

February 16, 2015 at 10:16 am

Thanks so much for taking the time to respond. Overall this is invaluable for younger MDs who want to be involved in journalism in some way. Often we/they don’t realize it’s about more than just wanting to write. Many don’t have the time to take the courses, get immersed in the discussion, recognize the conflicts of interest, distinguish when reporting veers into advocacy. I’m trying to do it by working and asking questions–and I appreciate all those who take the time to help me along.

I agree with what MedPage Today senior writer Kristina Fiore told me (paraphrased): “If I were trying to become a doctor, I’d learn what you learn. But if you’re trying to become a journalist, it’s your job to come from it from the journalist’s angle, not the physician’s.”

John Mandrola

February 16, 2015 at 10:30 am

Thank you Mr. Schwitzer. I am a learner. And this helps.

Tazia K. Stagg

February 16, 2015 at 10:50 am

Add one more to the list of physicians who agreed with your post on Azar.

Tazia K. Stagg

February 16, 2015 at 12:12 pm

I feel like the world needs a lesson about financial and professional conflicts of interest, cognitive bias, and information asymmetry, as they relate to healthcare providers advertising their services.