On Call Magazine, January/February 2007

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Five years ago, the Women’s Health Initiative study reported a slight increase in breast-cancer risk among women taking hormone replacement therapy (HRT), and many television outlets and newspapers carried the story under the sensational headline “Hormones Cause Breast Cancer.” Although Lisa M. Jones, MD, MA, FACOG, a gynecologist at the New Bedford Community Health Center, had not yet seen this study, she knew immediately it was going to have an impact on her practice. The first day the story appeared, 47 women called her office, all wanting appointments right away. The nurses and front-office staff say most callers sounded scared, and all wanted to know whether they should stop taking their medication that day.

With HRT, a woman and her physician make informed, individual decisions about treatment, says Jones. The problem with the story that patients saw, Jones points out, like many other stories in the media, is that it only summarized key findings of the study and did not include details or nuanced information HRT patients would need to make decisions. Jones says media stories about scientific issues are somewhat like a rainbow painted in black and white: “It gives you a general idea of shape, but does not show its many colors.”

Despite these limitations, Jones says health stories that appear in the mass media (e.g. television, radio, Internet sites, newspapers, magazines) can be beneficial. Such stories can create “teaching moments” for patients and their providers. In fact, Jones is so interested in the interplay of media and medicine that she recently interned at ABC News’ Medical Division, where she saw firsthand the many challenges producers face in maintaining accuracy while trying to keep stories simple enough to be understood by a wide audience. Working with a team of producers and reporters, she helped investigate and evaluate medical news, and that experience enabled her to identify a number of strategies that health providers can use to stay informed and help patients deal with what they see in the media.

Pay Attention to the News

Jones recommends that providers stay up-to-date with the latest health news. She does this by watching the evening news and checking the Internet periodically throughout the day. She explains that media stories are often aired the same day that studies are published. This happens because most medical journals send articles to news outlets ahead of their publication date, “embargoing” them (that is, requesting these stories not be aired) for a defined period of time. In practice, this means that patients may see media stories on medical or health findings before providers have reviewed the research. Jones knows how awkward this can be. “It is very difficult to speak intelligently about a study you’ve never seen,” she says.

Pay Attention to the Ads

Direct-to-consumer (DTC) advertising is another example of media attention that can affect medical practice. Unlike news stories, DTC ads (usually for specific medications) are aired repeatedly over the course of many weeks or months. A recent study by the Food and Drug Administration found that DTC ads have both positive and negative effects. Positively, “DTC advertising seems to increase awareness of conditions and treatments, motivate questions for the healthcare provider, and help patients ask better questions.” Negatively, “DTC advertisements overstate drug efficacy and do not present a fair balance of benefit and risk information.”

Pay Attention to the Shows

In addition to news stories and advertising, television shows such as Grey’s Anatomy and ER can impact patients’ perceptions of medical care. Many of these shows create unrealistic expectations about access to care, says Jones. As examples of ways popular shows can distort patient perceptions, she cites doctors who solve all medical mysteries within the allotted time; shows in which the same doctor gives a diagnosis, performs all scans and tests, and also does surgery; and shows that imply there is always a quick and direct line from symptoms to diagnosis.

Pay Attention to Spikes in Phone Calls

In most medical offices, front-desk staff and nurses are the first to speak with patients. Jones asks that everyone working in her office be aware of spikes in the number of calls about certain topics or specific health stories. Here is what she recommends when spikes occur:

• Prepare a standard office response. Jones prepared a script for nurses and office staff to give in response to patients’ calls about the Women’s Health Initiative study. It said, “Yes, the study came out yesterday and we know it is in the news. While the journal article is not yet widely available, Dr. Jones is confident that continuing your HRT medication in the short term will not create additional risk. Let us make you an appointment to speak with her in the next week after she has personally reviewed the article.” Jones finds that standard office responses such as this help to reassure patients that the situation is not an emergency and also offer an acceptable follow-up plan. Staff benefit from prepared scripts, too, as they can confidently communicate a message that the doctor has approved.
• Research the research. When Jones hears about a new health story, she not only reads the peer-reviewed research but also investigates the quality of journalism. One of the first sources she consults is the Foundation for Informed Medical Decision Making’s Web site, www.healthnewsreview.org. Run by the School of Journalism and Mass Communication at the University of Minnesota, this site uses stringent criteria to grade health stories on a scale of one to five.
• Refer patients to resources you trust. Often, patients want to know more about a specific health story. Jones recommends that offices provide lists of credible, accurate resources. Some Web sites that she consistently recommends are: WebMD; the Mayo Clinic Web site; and ABC News Health.
• Educate your patients in a timely way. Admittedly, office visits are too brief to discuss all late-breaking medical news. Jones suggests that providers help by having additional ways of educating their patients about up-to-date information. These include having a “health news” section on the office’s Web site; writing fact sheets or newsletters about timely topics; and having computers available with reputable Web sites already bookmarked.

As Always, Use Your Clinical Skills.

Media stories should enhance, not overwhelm, patient-provider interaction. Ultimately, Jones uses good clinical skills to make diagnostic and treatment decisions. “Just because patients think they have something wrong, it doesn’t mean they do,” she says. She adds that medicine is inherently messy and complicated. Providers can help by recognizing the impact of the media and helping patients more fully understand what these stories mean in their treatment and care.

How to Find Out More:

Lisa M. Jones, MD, MA, FACOG is a practicing gynecologist at the Greater New Bedford Community Health Center in New Bedford, Massachusetts. She is also president of her own consulting practice, WellLife Education. One of her services is script preparation about women’s health issues.