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Island of Doubt: When reporting on patient stories, trust, but verify

Island of Doubt: When reporting on patient stories, trust, but verify

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[Photo: John Moore/Getty Images]

“Trust, but verify.”

Suzanne Massie, an author who had spent time in Russia during the Cold War, taught this Russian proverb to President Ronald Reagan. It became one of his signature lines in talking about nuclear disarmament. The United States needed to show good faith with our Russian counterparts but also needed to verify the steps they were taking to disarm.

I write this not because we seem to be in many ways living in a Cold War flashback today but because trusting and verifying are the two key steps in handling the messy business of walking through a person’s medical records with them for a story.

First, the trust.

If you have succeeded in helping a source get access to their medical records, you already have reached across, in essence, to shake hands and shown them good faith. Their records are important, most of all, to them. They could help them as they pursue treatments and care in the future. They could help them in workplace disputes, in insurance claims, and in legal cases.

But the chances are good that they already have told you a bunch of things before you ever looked at chart, X-ray, or test result. You likely have a very specific timeline and narrative in your notebook that reflects a very specific timeline and narrative in the heads of the patient and the patient’s family.

When you start combing through the medical records, that’s where it becomes messy.

Dates are different. Times are different. Medical staff are different. Diagnoses may be different, too. Your job as a reporter is to find the real story. This will necessarily involve checking what your sources said against the records, and vice versa. Medical staff may have altered the patient’s records to cover up a mistake. Or the physicians involved may not actually be physicians.

I said in an earlier post that you should distrust your sources, and you should. But you shouldn’t communicate to them that you distrust them. They don’t need to feel blamed or shamed about something being amiss between what they told you and what the records say. (Note: this is assuming that they themselves — physicians, nurses, heads of health care organizations — are not the focus of an investigative story looking into something they did wrong.) Accusing a source of lying should be reserved for the types of stories where the trustworthiness of the source relates directly to the story.

Instead, walk through the medical records with the patient or the family. When you find discrepancies, have a discussion about them. This is the verification part.

An important piece of that verification effort is to bring in some outside expertise. You will not understand all the acronyms, abbreviations, and many of the chicken scratches in those medical records. But if you are well sourced on the health beat, you will know doctors and other medical professionals who will.

They can help you decipher what a particular alphanumeric code might mean. They can help you interpret the difference between a smaller error and a life-threatening mistake. They can tell you who else you need to talk to.

In sum, a patient’s medical records are a conversation piece. They offer thousands of points of discussion. You need to curate as you go and decide what are going to be the most important elements of your story. Focus on those. Verify those. And you will publish feeling much better than having relied solely on the emotional, verbal testimony of a patient or someone who just lost a loved one.

[Photo: John Moore/Getty Images]



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Be careful of complaints or diagnoses of "convenience" in a medical record. For example, to have a colonoscopy covered by insurance a patient may need to have a medical complaint, such as abdominal pains, so this complaint goes in the chart. Another one is benign prostatic hyperplasia so that a doctor can order a PSA test, Then these remain as part of the patient's medical history, even though the compaint or the diagnosis never existed. (And while I'm on the subject of "medical history," it is a stupid convention that medical staff ask, "Has anything changed in your medical history?" You can't change history, except maybe in the old Soviet Union. What they should be asking is, "Has anything changed in your medical condition?"

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“Racism in medicine is a national emergency.” That’s how journalist Nicholas St. Fleur characterized the crisis facing American health care this spring, as his team at STAT embarked on “Color Code,” an eight-episode series exploring medical mistrust in communities of color across the country. In this webinar, we’ll take inspiration from their work to discuss strategies and examples for telling stories about inequities, disparities and racism in health care systems. Sign-up here!

The USC Center for Health Journalism at the Annenberg School for Communication and Journalism is seeking two Engagement Editors to serve as thought leaders in one of the most innovative and rewarding arenas in journalism today – “engaged reporting” that puts the community at the center of the reporting process. Learn more about the positions and apply to join our team.


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