From Journalism to Medicine and Back Again

Tom Linden seemed to be on a fast track to a successful career in journalism.

He was the editor-in-chief of his high school newspaper in Southern California. As a college student at Yale University, Linden got his reporter's legs at the Yale Daily News and covered the New Haven Black Panther trials for the Los Angeles Times. When he graduated in 1970, he won a fellowship and secured a book deal to write about army deserters in exile who were protesting or escaping the Vietnam War.

After one year of research, though, he had completed magazine and journal articles but never wrote the book.

"I found it incredibly devastating to my sense of self as a writer and an author," Linden says. "I thought I didn't have what it took to be a journalist-author." That is when he decided to take a more traditional path and go to medical school. Fast forward thirty years, and these days you'll find Linden back in the throes of the news media. 

Linden spoke with Career GPS about how he returned to journalism for good. Keep reading to get his advice for health practitioners-turned-journalists and journalists who want to cover the health beat. This week's career listings are at the end of this post, where you will find them every Friday. If you have ideas for future posts, you can log in and let me know. Keep up with Career GPS by signing up for weekly newsletters or via RSS.

Linden was not satisfied with being a medical student and later a psychiatry resident. "Very early on I realized I missed journalism. I missed telling stories, I missed the camaraderie of journalists, I missed the whole journalistic environment. I felt like a fish out of water in medical school," Linden recalls. "I never felt creatively satisfied as a physician or a medical student."

So after just one year of practice, he shifted from his medical career and began to move up the ranks of television news, paying off his student loans with the reduced wages of a journalist by living a modest lifestyle. In 1986, he started out with a health segment on an NBC affiliate in Chico, California and eventually became their news anchor. In 1989, Dr. Linden stopped practicing medicine altogether to work full-time for CNBC as their first health and science reporter. He went on to work for KRON-TV in San Francisco, Fox 11 News in Los Angeles and on the Physicians' Journal Update program on Lifetime Medical Television Network. Now, Dr. Linden is a professor of journalism and the director of the medical journalism program at the University of North Carolina. He is also the author of the recently published New York Times Reader: Health & Medicine, recently reviewed by Accidental Wonk blogger Barbara Feder Ostrov.

The Q&A below is edited for length and clarity.

Angilee Shah: I have two questions about your transition from medicine back to journalism. One is practical and the other philosophical. First the practical question: What about the money? As a practicing physician, I'm going to guess you made a lot more money than at the local television station.

Dr. Tom Linden: Much more money. I had a rule when I was working as a part-time journalist that I wouldn't work for free because I felt I needed to be valued for what I did. But I was paid what the entry level reporters were paid, and as I recall it was in the neighborhood of an hourly rate that was equivalent to $20,000 a year. I was basically working half-time for less than $10,000 a year and supporting my journalism habit with my income as a psychiatrist. I took a big financial hit but I didn't care because I felt it's really important to be personally satisfied with how you spend the bulk of your time. I was happiest as a journalist. I know I could have made much more money as a doctor but money wasn't an issue for me.

I think many physicians are slaves to their lifestyles. I know many physicians who have a lot of creative interests and aspirations and are dissatisfied because they don't have the time to pursue them. Some of them love medicine and some of them are disenchanted with medicine. But if you want to make that transition, you have to be willing to accept a much more simple lifestyle. And that's the calculation I made. I was willing to cut back my lifestyle, which was never very extravagant anyway, and live on less to do what I love. Eventually I did earn a comfortable living. I think if you do what you really love you're going to be happier. You may make more money if you're a health care provider, but I think if you love journalism and you're good at it, you can make it financially.

The second, more philosophical question, is about many doctor-writers I've met who have anxiety. They worry that they are not good enough writers or storytellers. What kind of advice can you offer them about how you overcame your anxiety?

I didn't have anxiety about storytelling, but I did have anxieties about embarking on a huge book project. That was kind of the early failure in my life that led me into medicine. But I think I learned something from that: You have to be willing to deal with failure as a writer or journalist. If you're in the television business you have to be ready to be let go, fired. There is no permanency in a journalistic career, there is no secure life. You have be willing to live with insecurity.

In terms of getting writing skills, I think it's really essential that you have a strong background in writing and English. You have to write a lot and you have to have your writing critiqued. Practice doesn't necessarily make perfect, but it makes you much better. I've also been fortunate more recently to have a really great editor, who edited The New York Times Reader: Health and Medicine Reader, Jane Harrigan. Even now, after all these years, I still think every day that I can improve my writing. You need other people to critique you. I don't think anybody is their own best editor.

You wrote an essay for Electronic News about four doctors who covered the January earthquake in Haiti for big television networks. Why do you think it is so popular now to send doctors into the field to cover emergencies?

I think it gives networks and television outlets immediate ratings boost. When they report on health and medicine, I believe viewers consider physicians very credible. The added ratings draw is when these physician reporters are actually pictured delivering health care.

I'm not a fan of that kind of medical reporting. I always had a rule when I was a television reporter -- and I still do television reporting in concert with my students for North Carolina Public Television -- that if anyone ever contacted me when I was reporting that I would not see that person in my practice. And I would not be pictured delivering health care in a report when I was the reporter.

I think it presents a conflict of interest, as I outlined in my Electronic News essay. The biggest minefield in my mind is that the issue of consent is very shaky when a physician reporter is delivering care and at the same time reporting on the work that he or she is doing, especially for patients in disaster zones or developing countries where there are few health care providers. I don't think a patient can voluntarily give consent when the implicit threat in their mind might be, 'If I refuse to be pictured, perhaps that physician will deny me care.' I'm not saying these physician reporters would ever do that, but I don't think it's a free, voluntary decision of consent for these people who are being treated by physicians who are reporting on them.

Also, I think you have to ask yourself, would some of the television coverage by physician reporters that happened in Haiti have ever been done in the United States? If the answer is no, I think you have to ask yourself why.

Your proposed guidelines include a line that reads, "When physician journalists become the story, medical reporting loses its way." We have physicians in the ReportingonHealth community who blog or write columns for their local papers. Does this kind of personal writing have the same pitfalls as the kinds of television reporting you discuss?

It certainly has potential. I think the pitfalls are much more obvious in television reporting because it's very hard to make the person anonymous. In print or text reporting you can give pseudonyms to the individuals, you can alter their identities, you can change parts of their stories. But I think the issue of consent is still there. My basic rule is that if anyone reading that story knows who that person is by virtue of the story, then that person is not really anonymous.

There are people who do it very well. Atul Gawande is a great example in the New Yorker and in his books that are based on his New Yorker articles. I think he does a really good job of reporting case studies where he was the treating physician. Invariably when we discuss his stories in my medical journalism class at the University of North Carolina, students ask, is this ethical? Did the patient give consent? I don't know what the answer is to that. It is a gray zone.

There are other physician reporters who actually give extended dialogue of conversations with patients. And I always wonder, how was this discussion captured? Was it recorded? If so, did the patient give consent? If it wasn't recorded, was it recreated after the fact? If it was recreated after the fact, are these actually quotes? It's a real issue and every case has to be evaluated on a case-by-case basis. You have to think about this if you're a physician journalist. Every person you see as a physician is not necessarily grist for your mill, nor should they be.

I want to finish with two questions from your perspective as a professor and a teacher. What is your advice for physicians and other health care providers who want to extend themselves into journalism?

If you really want to be a journalist, I believe you have to be willing to work as a journalist for at least a period of time in a very serious way. In some cases, that may mean working full-time and stopping the practice of medicine. You may be able to keep both balls in the air at the same time, but I think you have to be willing to work in a journalistic news environment at some point in your career. I don't think you can simply be an armchair journalist where you're practicing full-time and writing in your free time without actually doing some shoe-leather reporting. I think that's a really important experience that all journalists should have.

If you're just writing essays, if you're like Lewis Thomas, the famous physician essayist who wrote for the New England Journal of Medicine and wrote some classic books, that's different. If most of your creative output are essays or fiction, that's different. But if you're going to be a journalist, I think you have to work as a journalist in a news environment at some point in your career, hopefully early on.

What advice do you give to people who want to shift into health reporting from other areas of journalism?

I think it's really valuable to have a background in the sciences, and perhaps medicine or health in particular. It's very helpful but I don't think it's a prerequisite. As proof of that, in my book I did extended interviews and have Q&A with five New York Times reporters. A couple of them, some of the best reporters on The New York Times health beat, don't have a science background. In particular, I think of Tara Parker-Pope, who majored in sociology, and Gardiner Harris, the public health reporter who majored in history in college. Other reporters whom I interviewed, Benedict Cary and Gina Kolata  had mathematics backgrounds.

The bottom line is the more you learn about science and understand the way science works the better reporter you'll become. However, some reporters do learn on the job and they're very good reporters so I don't think it's absolutely necessary to have an advanced degree in the sciences or the health sciences. It shouldn't stop you if you're interested in the subject matter.

Is there anything else you want the ReportingonHealth community to know or anything you want to say that I didn't ask?

I think one important idea to keep in mind is that health reporting and medical reporting is not all that different from any type of beat reporting. All the rules that apply to good journalism whether you're covering business, sports or politics, apply to health and medical reporting. So for those health care providers -- physicians, nurses and others -- who want to transition into health journalism, I think it is really important to learn the basics of good reporting. You don't necessarily have to go to a journalism school to do that, but I think journalism schools are a really good resource. I would strongly advise any health care provider who wants to transition into health journalism to check out their local journalism school. If possible take some basic writing and reporting courses and also, if possible, take some more advanced health or medical reporting courses. I think that's really helpful and will help you hone your craft.

Job Opportunities and Awards

As promised, here are job listings and an awards program you might be interested in:

Education and Health Care Reporter, Craig Daily Press (on JournalismJobs.com)
Location: Craig, Colorado
Status: Full Time
Medium: Newspaper, Magazine, Online

Media Business Development -- Health, AOL (on paidContent)
Location: New York, New York
Status: Full Time
Medium: Online

Staff Editor, Psychology Today (free registration required at mediabistro.com)
Location: New York, New York
Status: Full Time
Medium: Magazine and Online

American Association for the Advancement of Science  Kavli Science Journalism Awards
Eligibility: Awards are for individuals whose work has been published between July 1, 2009 through the end of June, 2010. With the exception of an award for children's science news, entries mush be published by a U.S. news organization.
Award: $3,000 is awarded in each of eight categories.
Deadline: August 1, 2010
From the Website: "Since their inception in 1945, the awards have gone to more than 300 individuals for their achievements in science journalism. The winning journalists have helped to foster the public's understanding and appreciation of science. Independent screening and judging committees select the winning journalists and their entries based on scientific accuracy, initiative, originality, clarity of interpretation and value in fostering a better understanding of science by the public."