New story in Health from Time: In a Time of Pandemic, TV Doctors Wield Growing Influence. Is That A Good Thing?

When the history of the coronavirus pandemic is written, people will remember the rubbish as much as the real. We’ll remember President Trump musing aloud about injecting Americans with disinfectant; psychologist Phil McGraw—TV’s Dr. Phil—arguing against the nationwide lockdown on the grounds that people die from cigarettes, automobile accidents and drownings and yet we don’t shut the country down for those; and Dr. Mehmet Oz seeming to advocate that a two or three percentage point increase in mortality rates (which would be the equivalent of some 8-9 million Americans lives lost) wouldn’t be such a bad trade off for reopening schools.

But we will remember too the people who have gotten it mostly right: the doctor-journalists who usually play a supporting role in network and cable newscasts and have now become the leading performers. For the better part of two months, both the evening news programs and round-the-clock cable fare have become all coronavirus all the time, and reporters with M.D.s have effectively become bedside physicians to a nation, ministering to 328 million Americans.

The phenomenon has been its own strange form of telemedicine—not the one-on-one Zoom sessions that homebound Americans are having with their GPs and specialists and psychologists, but national group therapy, live-streamed daily, from TV studios, from the field, from the rostrum of the White House press room. The doctors, like it or not, now have a waiting room that’s filled with the population of a nation—and their job is a commensurately complicated one.

“I understand that people are out there listening to me, and I’m the doctor,” says Dr. John Torres, emergency medicine specialist and NBC medical correspondent. “I very much try to understand that this is not just the physical manifestation of the coronavirus that I’m working with. There’s a mental manifestation too.”

“The truth is really important right now,” says Dr. Sanjay Gupta, neurosurgeon and the chief medical correspondent for CNN. “I feel like as a doctor there are times you really have to give people bad news but you want to do it in a very empathetic way. I like borrowing from the old Maya Angelou idea: it’s not always what you say, it’s how you make people feel.”

But questions have been raised about the very different imperatives that drive the three different professions at play: physician, journalist, TV personality. About the power of a single comment gone sideways that can mislead audiences, sometimes into taking chances they oughtn’t take. Even about whether TV doctors should be in the business of bucking up the nation’s mood at all, or should instead just stick to serving the facts, without any additional morale-boosting or comforting.

“Walter Cronkite was considered the most trusted American when he was an anchor and he would always end with ‘And that’s the way it is,'” says Thomas Cooper, professor of Media Ethics at Emerson College in Boston. “There’s that almost pontifical pronouncement that people want in an age of uncertainty. All of that is what audiences are looking for from TV doctors now.”

But can TV doctors do that—and should they even try?

Hippocratic hierarchy

The American Medical Association (AMA) does not fool around when it comes to doctors crossing the line from the examining room to the green room. While the organization tolerates TV moonlighting, its constitution and bylaws include an extensive section setting forth the ethical standards their members are supposed to meet when they go in front of a camera. Some of the guidance is anodyne stuff: strive for accuracy; include both benefits and risks in discussions of treatments; refrain from making clinical diagnoses of public figures; and always remember you are a doctor first and journalist second.

But the AMA gets more specific too, offering guidance tailored to the different ways different kinds of doctors interact with the media—the head of the federal agency who delivers occasional press conferences; the university researcher who is regularly approached by the media for comment and quotes; the doctor who is also a daytime talk show host.

In the current pandemic, Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, and Dr. Deborah Birx, the White House Coronavirus Response Coordinator, are both firmly in the first of the AMA’s three categories. They have become among the most conspicuous faces of the pandemic response.

Fauci in particular, says Cooper, is “the household name type of personality who [Americans] would most want to spend an evening with over the dinner table.”

“I truly believe he is a hero,” says Dan Fagin, professor of science journalism at New York University and author of the Pulitzer Prize-winning book Toms River.

But heroes have their kryptonite, and in the cases of Fauci and Birx, that comes in the form of serving at the pleasure of the president—a president who does not tolerate contradiction well. When Trump recommended disinfectant and ultraviolet light as treatments for COVID-19 at an April 23 press conference, the camera caught Birx on the side of the press room looking down, as if she hoped the floor would swallow her up. Fauci has not rejected Trump’s suggestions in any full-throated way, though he certainly has not endorsed them. But TV doctors, who serve at the pleasure of their networks and within the embrace of the First Amendment are freer to say what they choose about governmental policy.

That cuts both ways. TV networks have their ideological biases, and what counts as fact on one network is often seen as fiction by viewers of another—especially in the cable news wars. On the other hand, robust debate has always been a central pillar of American journalism. Either way, TV doctors benefit.

“I think sometimes the [doctors] who are in the public service part of this get a little stuck,” says Gupta. “They find themselves hedging on this and I feel for them. But I don’t have to hedge. So when something is wrong, when someone says we should study whether a disinfectant that works on a surface would work in the body, [I can] say it clearly, ‘No. We don’t need to study this. We know the answer to this.'”

Threading the needle

One of the trickiest parts of the television doctor’s job is managing not only the information that they have to deliver, but the impact it has on viewers. Early in the coronavirus epidemic, Jon LaPook, gastroenterologist and chief medical correspondent for CBS, conducted an interview with an infectious disease specialist from Johns Hopkins University. LaPook mentioned the need to offer the public some words comfort or encouragement during a scary time. His guest responded that that was not his role, that he represented departments of public health, not departments of public reassurance. Yet, LaPook and others maintain that it’s important to strike a balance between cold reality and cautious optimism, between making an audience feel better and scaring the daylights out of them. Journalists may not have to answer to a temperamental president, but they do have to answer to viewers who have plenty of other channels to choose if the TV doctor they’re watching leaves them depressed.

“You want to tell people, ‘Look, I know we’re all worried, but this will have a beginning, middle and end,'” says LaPook. The key in those cases is often giving people actionable information—ways they can seize back a bit of agency from the virus. “Nobody likes to feel out of control, so then you talk about things people can do—social distancing and sneezing into the crook of their arm, for example.”

For Torres, the sequence in which news and advice are offered makes the difference. “One of the things that we’re taught [in medical school] is that once [we] say that word ‘cancer,’ patients are not going to listen to a single thing we have to say. So you give all the information up front and then you tell them the reason you’re giving them that information,” he says. “To a certain extent it’s the same thing here. It’s like, ‘Hey, I’m going to give you some information and here’s how you can use it.’ Then you tell them the repercussions if they don’t.”

Fagin, a journalist first, last and always, doesn’t agree with such a blunt-the-edges approach to bad news. “Sometimes reality is really awful and our job is to depict its awfulness,” he says. “The best health journalists should be saying to themselves, ‘What is the closest depiction of reality I can get? And if it happens to be hopeful, great. If it happens to be horribly bleak, well, I’m sorry but that’s just the way it is.'”

That’s exactly the message that ought to be taught in journalism schools, but as with so many other things, what ought to be—and is—taught in schools often runs smack into a messier outside reality. A television doctor will never be precisely the same thing as a pure television journalist, and that’s not necessarily bad. In this pandemic, hard truths served up without a side dish of hope would be too much to ask most Americans to bear. There is a penalty to be paid for getting things wrong—as Drs. Oz and Phil learned. But there is a penalty too for not remembering that audiences are humans and humans need help to navigate bad times.

“I always try to mention that we are going to get through this,” Gupta says. “But for the next period of time that’s going to require a different way of life.” It’s also going to require a little national hand-holding from the doctors in a position to offer it.