The dog ate my reporting

August 2007 -- On May 13, The New York Times ran a long piece by reporter Lawrence K. Altman, M.D., about the ongoing recovery of New Jersey Gov. Jon Corzine from a serious auto crash in April: "In Corzine's Recovery, Doctors Cite Grit and Luck." The physician-centric piece included many quotes from Cooper University Hospital physicians, but not one from a nurse--though Corzine spent eight days in the ICU. And the piece gave credit for things nurses do to physicians, to others, or to no one. In response, the Center posted an online analysis, and its executive director wrote a letter to Dr. Altman. Dr. Altman wrote back, arguing that he did ask to speak with nurses, but that the two nurses the hospital made available to him played only a marginal role in Corzine's care. The Center's reply notes that we commend Dr. Altman for considering our concerns, but that his limited effort to speak to nurses will do nothing to alter the piece's damaging effect on the public. We also explain that we understand journalists are not solely responsible for the undervaluation of nursing evident in pieces like this. Many nurses are reluctant to speak up, and many hospitals fail to encourage it. But journalists should do more than simply rely on what the institutional subjects of their stories tell them. Health reporters should learn about and convey the key role nurses really play in patient outcomes, and work to give readers the real story. Would Dr. Altman have accepted it if the only physicians the hospital provided to him were marginally involved in the Governor's care?

The Center's original analysis of the May 13 New York Times piece

Dr. Altman's response to the Center

The Center's reply to Dr. Altman

Summary of the Center's analysis of the May 13 New York Times piece "In Corzine's Recovery, Doctors Cite Grit and Luck," by Lawrence K. Altman, M.D.:

Physicians save Corzine; other work occurs

May 13, 2007 - Today The New York Times ran a long piece by reporter Lawrence K. Altman, M.D., about the ongoing recovery of New Jersey Gov. Jon Corzine from a serious auto crash last month: "In Corzine's Recovery, Doctors Cite Grit and Luck." The piece is physician-centric. It includes many quotes from Cooper University Hospital physicians, but not one from a nurse. And it gives credit for things nurses do to physicians, to others, or to no one, through the "this happened"-type constructions the news media often uses to describe nursing work. Readers could be forgiven for thinking that physicians provide virtually all bedside care to critical patients who spend weeks in the hospital, monitoring and keeping them alive 24/7. Gov. Corzine spent 18 days in the Hospital, 11 in the ICU. Yet the only specific credit any nurse gets is for lip-reading his requests for medication and water while he was on the ventilator. We regret having to say "nurses did that!" over and over when the media presents the key care of a VIP as being provided entirely by physicians, as it usually does. But it is necessary if we want a world in which credit for health care outcomes, and the resources that go with that credit, are allocated based on professional merit and the facts. See full analysis...

Dr. Altman's response to the Center:

Dear Sandy Summers,

Thank you for your comments.

I am disappointed that my article on Gov. Corzine's recovery disappointed you and that you interpreted the story as disrespectful of nurses and their work. That is far from my view of nursing.

I suspect that your perception arises from a misunderstanding of what the story was about and what went into reporting it.

The article was not a feature or essay that solicited comments from nurses and doctors not involved in the governor's trauma care.

Instead, it was a news story designed to report what happened in a specific case. The story was based on interviews with members of the medical team directly involved in that patient's care so that they (paramedics, EMTS, helicopter pilots, ER doctors, nurses and other staff) could relate what they did to save Mr. Corzine's life.

Contrary to your statement, I believe I do understand the overall difficulties in the care of a trauma patient. That is why I specifically asked to talk to nurses about their roles in his case. But the two nurses Cooper presented played only a small role in the governor's care. Unfortunately, these nurses had little to say in the interviews about the issues you raised, though they were given that opportunity. One nurse was on duty when the governor arrived in the resuscitation area but she was not involved in his care. She did not work again until a few days later, in the trauma ICU where she did not care for Mr. Corzine. In the story, I reported what a second nurse I interviewed did to judge the dosing of pain killers. Other nurses were not available, and I was not given their names.

The hospital's public relations director sat in on the interviews and did not offer any further suggestions or details. Because of your letter I checked back with Cooper about any complaints about the article from nurses or others. There were none, I was told, but there were compliments.

If you believe the doctors disrespected nurses and took credit for the work nurses really do, may I suggest that you write them directly.

I will be happy to keep you in mind for other stories that involve nursing.

Again, thank you for your interest.

Sincerely,

Lawrence K. Altman, M.D.

The Center's reply to Dr. Altman:

Dear Dr. Altman:

Thank you for your response to our concerns about your article of May 13, "In Corzine's Recovery, Doctors Cite Grit and Luck."

We really appreciate your taking the time to consider our concerns about the poor portrayal of nursing in your piece and to send a written a response. Too often, the creators of influential media products do not seem to give these issues the attention they deserve, even with significant input from the Center and others. We hope that this exchange will contribute to greater understanding of difficulties in giving the public an accurate view of the real role nursing plays in care.

Your letter is mainly an argument that you did the best you could to give readers a sense of the role nursing played in Gov. Corzine's care based on input from the two nurses the hospital made available to you, nurses you admit played only a small role in Corzine's care. However, the Center's main goal is not to assign blame, but to explain the physician-centric effect the article had--an effect that you do not dispute--so that you and others understand our view of how that occurs. We wrote to you and we mention your name in our web site analysis because you are the one person we can be sure played a key role. We understand that your editors and various players involved in Gov. Corzine's care all likely share responsibility for the piece's impact on the public.

As we explained, the piece conveys the overall impression that only physicians did anything of importance in Gov. Corzine's care. The piece features many quotes from named physicians, and their care is described in great detail. At several points, these physicians express views on issues in which nurses would likely have more knowledge and expertise. Gov. Corzine spent eight days in the ICU, where elite nurses take the lead in keeping critical patients alive 24/7. Yet there is nothing about this from any nurse, only the passing note from you that one nurse was able to lip-read the Governor's needs for pain relief and ice water. Of course, simply noting that you spoke with nurses conveys that they were involved, but not that they had anything significant to say. In fact, including so many quotes from physicians but none from nurses suggests the nurses did not have anything important to say.

We do not share your apparent view that a journalist's responsibilities extend only to the sources that the institutional subject of a story chooses to make available. You suggest, somewhat condescendingly, that I must not have understood that the piece was an account of "what happened in a specific case," rather than a more general piece soliciting expert comment from health workers who were not involved in Gov. Corzine's care. Then you essentially argue that because the two nurses the hospital provided "played only a small role" in his care, you are not responsible for any failure to convey the real role nurses played.

However, your piece gave a distorted, physician-centric view of what happened in this "specific case." We think journalists have a responsibility to question and investigate the subjects of their stories. This is especially true where the reporter appears to have special expertise in the subject of the piece and makes a point of publicizing that credential, as you do. You claim to "understand the overall difficulties in the care of a trauma patient," and say this is why you specifically asked to speak with nurses. We commend you for doing so, and for giving the nurses an opportunity to express their views. But professional responsibilities extend beyond completing a checklist. In this case, we think it is the reporter's job to push for people who actually know about his story's subject, not to allow an institution like the hospital to simply give you people who don't know much and call it a day. If the hospital isn't allowing you to give readers that story, you ought to ask them to do so, or find another way to get the information. If you do not, you cannot claim to be giving readers a fair account of what happened.

You assure us that the hospital public relations director sat in on your interviews with the nurses and offered nothing more, as if he or she was not just representing the hospital but also directing your story. Let's say a journalist was reporting on a U.S. presidential candidate's health plan, and in particular how the candidate would fulfill promises to cover the uninsured. Suppose the campaign manager chose not to tell the reporter the financing details of the plan. Would that excuse the reporter's failure to explore what those details might be in her article?

We understand that the news media's frequent failure to convey the real nursing role in care is not solely the fault of journalists. We find it very credible that a hospital would have failed to provide a reporter with access to the nurses who were most involved in a VIP patient's care. Many hospitals do not make a significant effort to communicate the role nurses play, even though hospitals exist to provide nursing care. Key factors include entrenched biases as to the value of nursing, as well as a tendency to view physicians as revenue generators to be promoted, and nurses as cost centers to be contained. As you know, nurses' professional services are not even independently billed, but instead folded into room and board charges, as if they were so much fruit cocktail.

Nurses themselves also bear responsibility for their poor visibility. Many remain captive to the profession's enduring "virtue script," which requires that they deflect attention from their real achievements (and allows them to escape responsibility for problems). We know that many nurses would have been reluctant to communicate with the media, even as part of a story that was likely to give them fair or even laudatory treatment, because they have been socialized to keep their heads down and defer to the physicians who are supposed to get all the credit.

Of course, we do not know what specific factors might have played a role in this hospital's apparent failure to put you in touch with the nurses who actually provided hundreds of hours of expert care to Gov. Corzine and played a central role in saving his life. But we do know that your duty to report what happened in this "specific case" extended further than the choices of the hospital's public relations director. Would you have accepted it if the only two physicians the hospital provided to you were marginally involved in the Governor's care?

Thank you again for considering our views and taking the trouble to provide a real response.

Sincerely,

Sandy Summers, RN, MSN, MPH
Executive Director
Center for Nursing Advocacy
203 Churchwardens Rd.
Baltimore, MD 21212
410-323-1100
ssummers@truthaboutnursing.org
www.truthaboutnursing.org