REMAKING HEALTH CARE
With all due respects to Rachel Maddow, Anderson Cooper, and all their brethren in the land of political punditry, what the world needs now is some good old-fashioned consumer reporting. Yes, I mean the kind of journalism that has largely vanished over the years in favor of talking heads, quick takes, pontification by “experts” and endless summaries of reports and studies pushed to the media about every conceivable health care topic. It wasn’t until two days ago that I, as a New Yorker trapped in an apartment for the foreseeable future, got some real news I could use. In a televised press conference, New York City’s health commissioner clearly laid out the steps in one-two-three-four fashion that New Yorkers should follow if they get sick. Finally, some useful information without a political tinge!
At this moment that’s the sort of news the media needs to dispense. The public needs all the help it can get in negotiating a changed world — health care and otherwise. That includes information on everything from where to buy food to avoiding scams promising miracle cures to understanding what your health insurance would pay if you need hospitalization. “People are desperate for information,” says Jason Sanford, manager of communications and content at the Ohio News Media Association. “Where do you get good information?”
Wearing my hat as a press critic (I spent 25 years writing press criticism for Columbia Journalism Review), I set out to see what kind of information news outlets in the American heartland are offering, including daily and weekly newspapers and public radio stations. What I didn’t expect to hear was the toll that covering the virus is taking on reporters in the thick of it. Two public radio reporters covering health, Sarah Fentem at St. Louis Public Radio and Bram Sable-Smith of Wisconsin Public Radio, talked as much about their personal struggles of covering the virus as the content of the stories they turned out.
“My job is to think of the worst-case scenarios,” Fentem told me. “Health can be a rough beat on you and this has just ramped up with no respite. I can’t get out to recharge my batteries and find myself having a hard time sleeping.” She added that “our bosses have said take time for yourself,” but still she still feels the same tug felt by all journalists — wanting to be on the front lines bearing witness to this catastrophic event. Fentem said her outlet’s staff is now working from home, which sometimes means relying on others to tell her stuff rather than seeing and interviewing people in person.
Fentem said she faced another challenge common to all health reporters right now. The sources she relies on are doctors who don’t have time to talk to reporters and make connections for her. “Medical sources are hard to get even on a good day,” she said. “The sourcing and methods to get information are more difficult right now.”
I asked Fentem what her listeners were most interested in at the moment, and her answer surprised me, too. She mentioned the practical, how-to questions asked by listeners on the station’s “Curious Louis” blog, a close cousin of the Action Line columns newspapers of old offered to help readers resolve consumer complaints. Some of the questions listeners asked ranged from personal problems — “Should I shower after a walk?” “Is it safe to buy groceries?” — to broader public health issues: Are families allowed to gather for funerals? Is the virus mutating?
Sable-Smith of Wisconsin Public Radio shared similar concerns with me. “We want to bear witness but have the duty to stay home and not spread this thing. That’s something I struggle with every day,” he said, raising another conundrum. “There’s a really strange feeling now balancing wanting to check in with everyone you’re reporting on to see how they’re doing while holding these institutions accountable for providing vital information, like the number of ICU beds or ventilators available.” He says it’s important to do both.
One of the best service pieces I’ve seen of late is one that grew out of Sable-Smith’s own struggle to get a 90-day supply of insulin for his Type 1 diabetes. He got caught in a bunch of bureaucratic denials he thinks can be traced back to the pharmacy benefit manager. The hassles resulted in a fine Q&A for the public about what those with diabetes should know during the pandemic — everything from why diabetics have worse outcomes if the virus strikes to the wisdom of setting up mail order prescriptions.
And for other reporters looking into the diabetes angle, it’s worth asking why pharmacy benefit managers are controlling the supplies so tightly in these times and making it harder for patients. How does such a Scrooge-like practice, requiring multiple trips to pharmacies, square with the social distancing edicts and the self-quarantines imposed on patients like Sable-Smith who need maintenance medicines? Ginger Christ, a health reporter at the Plain Dealer in Cleveland, told me her paper, too, is working on a story about insurers denying extra prescriptions.
Christ said the Plain Dealer is also covering efforts by local hospital systems, the Cleveland Clinic and University Hospitals, traditional rivals in good times, to develop a regional approach to sharing information and providing the care the city knows will be needed. That’s a story journalists in other areas where a few big hospital systems control the care might want to cover locally as well. Christ added that the health team at the paper is not focusing so much on stories about individual efforts like organizing food drives, but instead on those affecting very vulnerable people like the homeless. Stories about how the food bank needs more volunteers because the older people who used to help are now quarantined are handled by reporters at another part of the paper. “We chose not to tell that story,” she said. Instead the health team tackled the harder one of providing urgent services for the homeless, like public facilities to wash their hands. How do we protect the most vulnerable among us? “We’re trying to help people connect. It’s time to remind people we are all in this together.”
Smaller community news outlets are doing the same. Mike Konz, the enterprise editor at the Kearney Hub, a Nebraska daily with a 5,500 circulation told me, “The virus has given us a wealth of local stuff to write about. A little bit of humanity is coming out of this.” Konz relayed a story the paper told about a local man who once ran a barbecue restaurant but was now preparing 300 meals from a truck and delivered by volunteers to residents needing a meal. Konz told me he had just heard of a farmer who was running an ethanol operation and was going to begin making hand sanitizers. Konz was ready to chase down the story.
He added, “I think there’s interest in diversion, not just the gloom and doom part of it.”
Other editors in the Midwest described activities and efforts they’ve help organize to help keep their communities together. In Wabash, Indiana, The Paper of Wabash County, circulation 16,000, came up with a way for kids who are not in school right now to see their teachers. Teachers decorated their cars and drove around town waving at the children lining the streets. The Paper streamed the parade. Don Hurd, president and owner of the Hoosier Media Group, which owns the paper, said the “community enjoyed it and it gave teachers and students something to do.” The news organization also produced a video explaining the state’s stay-at-home order and a special online section on the virus. Hurd told me the organization is using all media platforms to “minimize the boredom and stress of being at home. We’re doing everything possible we can do to provide information so they can come out stronger on the other end.”
Dr. Doug Johnstone, a retired nephrologist in Martinsville, Indiana, told me, “Regardless of their demographic people don’t want a detailed lecture on how different COVID-19 is from SARS 1. The public I talk to wants quick information in easy digestible form based on fact that is not politicized.”
To that end Johnstone offered excellent suggestions for journos to think about as they scramble to cover the virus. As I looked over Johnstone’s list, I thought that Maslow’s hierarchy of basic needs might be a good framework for our stories. For those not familiar with Maslow, he was one of America’s preeminent psychologists of the 20th century. He posited a hierarchy of needs, beginning with the basics of food, clothing, and shelter, followed by safety, love and belonging, and at the top, self-esteem, and self-actualization. Using his pyramid as a lens, is it really surprising that stories about how to get food — which grocery stores are open and which restaurants still offer carry-out service — are universally popular right now? Or that the question “How do I avoid getting the virus?” tops Johnstone’s wish-list of stories he’d like to see.
Other urgent questions on his story list include:
• If I get it, will I be able to get appropriate tests and treatment? People are scared to death about being denied a ventilator, he says. Are they going to put me at the end of a barrel and give me morphine?
• How long do I have to stay away from elderly relatives after I recover? People are going to be asking this more and more.
• Is it safe to touch groceries and eat carry-out food? In other words, what is safe to touch? People want to know if they get carry-out, has everyone from the kitchen staff to those delivering the food used hand sanitizers, kept physical distances or stayed home if sick?
• Will my health insurance pay? Some people are starting to worry about this, Johnstone says, adding that “universal coverage” has come up several times among those he still works with. Jason Sanford at the Ohio News Media Association added more concerns he’d like news organizations to tackle, all of which reflect widely shared fears:
• What do you do if a hospital is full and have other medical problems requiring hospitalization? • What happens if you have other health problems like breast cancer and can’t get out for treatment?
• How do you deal with more minor issues like social isolation?
• What do you do if you can’t get out to pick up medicines? Good service journalism can help answer these questions.
We reporters look for the bad, the negative, the rotten apples, the flaws, the gotcha journalism we hope will win us a prize. That’s our stock in trade. Those stories are important, but my informal little survey of the Midwest, including my home state of Nebraska, has taught me that story after story of the mistakes made in this pandemic (and there are many as Politico and The New York Times have repeatedly told us) can either wait for a later moment or exist alongside those stories of the humanity and social solidarity that Ginger Christ wants to tell her readers. Shari Rudavsky, a health reporter at the Indianapolis Star, told me: “This is not easy stuff. We always want to give answers, but there are so many unknowns. We have not done such a good job of telling people what we don’t know.”
Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.
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