197708
Guidelines for Psychiatrists Working with
the Communications Media
RESOURCE DOCUMENT
Approved by the Board of Trustees, February 19, 1977
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"The findings, opinions, and conclusions of this report do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association. Views expressed are those of the authors."-- APA Operations Manual. |
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These guidelines were approved by the Board of Trustees of the American Psychiatric Association at its February 19, 1977, meeting, upon recommendation of the Joint Commission on Public Affairs.1 TO REAFFIRM THE American Psychiatric Association's long-standing policy of full, open, and honest communications with the American people, the Joint Commission on Public Affairs has prepared the following guidelines to help psychiatrists deal more effectively with the public media.
PART I. BASIC PRINCIPLES OF OPEN COMMUNICATION The American Psychiatric Association has an open policy with regard to the communications media. The Association encourages frank sharing of its business and concerns with bona fide representatives of the news media. Members are encouraged to cooperate with reporters on all matters within the expertise and interests of the psychiatric profession.
Public Relations Sound judgment, common sense, and the
Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry (1) should dictate psychiatrists' relations with the communications media. No amount of publicity or public relations can counteract poor performance. Psychiatrists are responsible for constantly evaluating their performance and that of the profession as a whole and for remembering that their actions reflect on the entire profession.
The promise of radical cures or boasting of extraordinary skill or success is considered unethical by the medical profession. Likewise, claiming expertise in broad social matters without proof or positive contributions to solutions can destroy public trust. It is not necessary to comment on every question from the press.
The Patient: Confidentiality and Privilege Release of information about individual patients must be considered in a different light from open communication because of the issue of confidentiality. The APA Board of Trustees adopted a Position Statement on Guidelines for Psychiatrists: Problems in Confidentiality (2), parts of which are quoted below:
The welfare of the patient is the first concern of the psychiatrist, and from this concern derives the psychiatrist's obligation to protect the patient's privacy and maintain the confidentiality of his communications. When, however, circumstances compel the psychiatrist to impart information about a patient to others, it is to be done in strict accordance with legal requirements and procedures, ethical guidelines, good judgment, and common sense, and always with the welfare of the patient as the underlying consideration. (p. 1543)
A psychiatrist should never reveal, except with proper authorization or, if necessary, under legal compulsion, for example, a court order, confidential information disclosed to him by a patient in the treatment process. Consultation with one’s own legal counsel may be necessary. (p. 1545)
Spectacular public crimes. In cases of persons who have been under psychiatric treatment and who subsequently become involved in spectacular public crimes or whose condition may constitute a threat to the welfare of the community, the confidentiality of records (other than necessary for proper medical treatment) should still be maintained. (p. 1545)
After death. After the death of a person who has been under psychiatric care, the pertinent principle of medical ethics cited above still applies. The confidentiality of the patient's communications should always be maintained except when the release of information is authorized by the proper person (i.e., next of kin, executor) or under proper legal compulsion. (p. 1545)
Other matters involving confidentiality have been discussed in another position statement (3).
The Psychiatrist as Commentator Although no guidelines or policies can be formulated that will cover all situations, the following precautions may be helpful:
• No individual can speak for the profession as a whole. Official statements are made only by the Trustees or those officers of the American Psychiatric Association empowered to do so. Among the 25,000 members, there is an infinite variety of opinions about any controversial issue.
• If one is in doubt, one should make no comment at all.
• Comments, if any, should be made thoughtfully. The reporter should be told that a statement will be prepared and that he/she will be called back shortly. Restraint should be the guiding rule in all contacts with the press, radio, and television. Understatement is usually more effective than excessive approval or denunciation.
• In major cases of national interest, the inquiry may be referred to the American Psychiatric Association Division of Public Affairs office in Washington, D.C.
• Reporters may be referred to pertinent published articles or monographs that deal with the issue under discussion.
• In no case should a comment be made that might reflect adversely on the competence or character of individuals directly involved in a particular situation, not because physicians should be mutually protective but because all the facts cannot be known in such circumstances.
• Consultation with the county medical society or district branch officials is always wise.
• Some reporters, like much of the general public, do not realize that psychiatrists are physicians. They should be told to accurately identify psychiatrists as M.D. rather than Dr.
PART II. SUGGESTIONS FOR GOOD MEDIA RELATIONS
Continuing positive relationships with the media are the best assurance of good media coverage. Frequent contact with reporters, editors, and other media representatives is far more effective than media relations efforts based on single attempts or efforts to counteract bad stories.
Responsible reporters are constantly seeking new ideas and sources to verify facts and present balancing points of view. The best time to correct errors is while the story is being written, not after it appears in print or on television. Therefore, it is essential in media relations to establish trust and confidence between the psychiatrist and the working joumalist.
Even if the media representatives are strangers, it should be remembered that they are our community partners and that for most of the community the media are the principal, perhaps the only, source of information on psychiatry, on new and old therapies, and on major health care issues.
The Division of Public Affairs at the APA Central Office maintains a list of media representatives in all parts of the country. The Central Office staff can help identify the members of the press in any given area and suggest the following examples of media relations activities:
• A district branch public information committee could be set up (or qualified spokespersons designated) to provide the media with accurate, up-to-date, and permissibly complete information on all medical matters of public interest.
• An annual luncheon or dinner meeting could be arranged for representatives of a district branch (such as president, president-elect, and the public information committee or spokespersons) and media people (such as publishers, editors, station managers, newscasters, and appropriate reporters) in which a free-wheeling, open discussion that can lay the groundwork for mutual understanding replaces an agenda.
•The media should be furnished with names, addresses (home and office), and telephone numbers (home and office) of the district branch public information committee members or of the designated spokespersons.
•In turn, a list of media contacts should be developed.
• An all-day briefing (or several shorter ones) could be held on medical topics for members of the working press, possibly in conjunction with the district branch or area annual meeting. This could be particularly valuable to reporters who are generalists but often handle health-related assignments.
Again, the APA Division of Public Affairs can help to implement these activities.
Conducting the Interview Encouraging the press to call on psychiatrists is only the beginning. What the psychiatrist says and how he/she handles him/herself is the heart of the matter.
Increasingly, the psychiatrist is called on to comment on a variety of topics. Psychiatrists may be asked to evaluate and explain human reactions to the latest catastrophe, to render opinions on such matters as euthanasia, birth control, abortion, and student protests, or to explain the behavior of some public figure. New and unorthodox theories of treatment of mental disorders by psychiatrists and other disciplines are being widely publicized, and comments are often solicited.
The reporter is usually seeking a simple, short, and direct answer to a question. The psychiatrist can best establish rapport by providing simple, concise answers. Admittedly, psychiatry does not always provide this type of reply. Asking the reporter questions like “How would you phrase what I’ve just said?” or “Could you play that back to me?” might help to avoid a misquote. However, reporters should not be asked to send a copy of an article before it is printed. Most news organizations have policies prohibiting this practice.
It may not always be possible for a psychiatrist to answer specific questions; he/she could help the reporter by suggesting other professionals (preferably two or more) who may be more knowledgeable about the specific matter. Since matters in psychiatry often involve divergent opinions, an accurate story should reflect these differences and more than one source will help assure more balanced media coverage.
On occasion, psychiatrists are asked for an opinion about public figures or an individual in the news. It is unethical for a psychiatrist to offer an opinion or diagnosis unless he/she has conducted an examination and has been granted proper authorization for such a statement. Even then, it is probably unwise.
How Can Bad News Be Countered? News against the medical field and news from it should be seen as two sides of the same coin. Both are prerogatives of a free society. The media generally are sufficiently fair to let the bad be answered, as well as the good be told.
A psychiatrist should never try to kill an unfavorable story that he/she has been forewarned about, unless it can be clearly and convincingly proved to the media that the story is inaccurate. Protest without proof does nothing but fan suspicion, and positive articles offered in the future might be viewed with suspicion by media representatives. Credibility, above all else, is essential to media relationships.
There are, however, effective ways for a psychiatrist to respond to unfavorable stories; this is easier if good media relations have been previously established.
After an unfair story appears in a newspaper, an oral or written reply might be prepared, approved, and presented to the media as expeditiously as possible. This reply can take the form of a suggested follow-up story, provided there is a story.
How Can Bad Views Be Countered? The Federal Communications Commission has stated that a broadcaster in having to devote “a reasonable percentage of … time to the coverage of public issues ... must be fair in the sense that it provides an opportunity for the presentation of contrasting points of view” (4, p. 13).
A contrasting point of view does not have to be presented on the same program or series of programs. The licensee is “simply expected to make a provision for the opposing views in his overall programming.”
What could be done if, for example, a TV commentator were to voice recurrent bias against psychiatric medicine or physicians in general? Beyond informing the commentator of opinions and supportive facts from the appropriate district branch, a psychiatrist should respect his/her freedom of expression. If the station has a talk show it might be advisable to suggest that a psychiatrist be invited as a panelist. However, it is usually best to avoid public confrontation with experienced commentators unless the facts are indisputable.
Just as a matter of course, a station might appreciate having physicians for panel discussions and interviews. If the discussion involves a controversial issue (such as national health insurance or involuntary commitment), spokespersons should be careful to maintain aplomb and stay on target regardless of how “loaded” or caustic the questions or opposing comments are.
Some newspapers accept guest editorials and articles. A special page opposite the editorial page that uses such contributions (i.e., an “Op Ed” page) might be a good place for a psychiatrist to submit an article for publication.
Another way to expose various viewpoints to the public is to organize discussion programs featuring speakers with different affiliations and opinions. The programs could be open to the public, and if media coverage were promoted, they could reach the public at large. Other organizations not directly involved, such as a university, could cosponsor the program.
CONCLUSIONS The basic tenet of good public relations is good work plus good communications. Media relations must always be seen as part of a larger end: a sound and constructive relationship with the community. Good media relations enhance psychiatry's standing with the community, and the reverse is equally true.
Sometimes the two overlap or interrelate - as would be the case with the press-covered public meeting. Nevertheless, community undertakings should not be planned strictly with an eye to publicity. The profession should be thought of as dedicated to service and not to self-service.
The only effective way to have favorable news reported in the media is to do newsworthy work that has a positive effect on the community. It may be necessary to notify the media of such activities so that the good news does not slip by unnoticed. Unfortunately, newsworthy activities that have negative side effects are not as likely to slip by. On such occasions the facts must be faced and no attempts should be made to hide from public scrutiny. Honest efforts to correct bad situations are far better than misguided attempts to conceal. It is encouraging to know that the good will usually balance out if, in fact, the good is there.
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1The Joint Commission on Public Affairs includes Shervert Frazier, M.D., chairperson, Miles F. Shore, M.D., Robert Michels, M.D., Ricardo Galbis, M.D., Arnold Werner, M.D., Eugene L. Usdin, M.D., Irving D. Baran, M.D., Alan I. Levenson, M.D., and Robert J. Campbell, M.D., Joint Commission on Government Relations liaison.
REFERENCES 1. The principles of medical ethics with annotations especially applicable to psychiatry. Am J Psychiatry 130: 1058-1064, 1973
2. Position statement on guidelines for psychiatrists: problems in confidentiality. Am J Psychiatry 126: 1543-1549, 1970
3. Position statement on the confidentiality of medical research records. Am J Psychiatry 130:739, 1973
4. You, Too, Can Have a Good Media Relations Program. Chicago, American Medical Association, 1975
Am J Psychiatry 134(5):609-611, May 1977
AMERICAN PSYCHIATRIC ASSOCIATION
Addendum to Public Affairs Guidelines
(Adopted by Board of Trustees, March 13, 1982) Part III Radio and Television THE AMERICAN PSYCHIATRIC ASSOCIATION ENCOURAGES THE RESPONSIBLE PARTICIPATION OF PSYCHIATRISTS IN RADIO AND TELEVISION PROGRAMS FOR THE PURPOSE OF EDUCATING THE PUBLIC ABOUT PSYCHIATRY, MENTAL ILLNESS, AND RELATED SUBJECTS; AND TO ADVISE THE PUBLIC ON APPROPRIATE SOURCES OF QUALITY MENTAL HEALTH CARE IN THE COMMUNITY.
GUIDELINES (You Probably Already Know This, But - )
There are three major types of programs on which psychiatrists may be asked to appear:
1. News shows - Psychiatrists are asked to comment on an issue in the news such as a bizarre crime or a new research breakthrough. The comment is often brief, lasting not more than one minute. There may be little time for preparation.
When the radio or television station calls, find out what the news reporter wants. If you decide you are the wrong person don't say “No comment.” Instead, say: “I'm not qualified to talk about that;” or “We're not ready to comment;” or “It would not be appropriate for me to comment.” If possible, offer to help the reporter find a psychiatrist who is qualified to respond.
If you decide to be interviewed, tell the reporter: “Let me check a few facts and call you right back.” Use the time to make notes on your intended responses and to determine what single point about the subject you want to be known and remembered by the public. Then return the call and answer the questions, making your key point in no more than 30 to 45 seconds. Don't read your comment and don't use complicated words. Use your natural speaking voice.
If a television station wants to film or tape you for a news segment, a film crew will probably be sent to your office or to any other designated place. When you meet the reporter, find out as much as possible about the story and what the reporter hopes to emphasize. During the interview, which may last 5-10 minutes, carefully consider each question before responding. Following the same rule for radio, keep your responses short, less than one minute, preferably 30 to 45 seconds.
2. Radio or television magazine show - Shows such as PM Magazine, or ABC's 20/20 often do short 15 minute mini-documentaries on mental health topics and may seek to interview psychiatrists for expert knowledge and information. Although actual air time may be short for the psychiatrist being interviewed - perhaps two minutes, total - the interview itself may be lengthy.
In such a setting, you will probably be asked to comment on an issue or provide information on a field in which you are an expert. You will almost always have ample time for preparation. If possible, watch the program in advance to observe the style, length of time guests appear, and the general tone the interviewers take toward their sources - friendly or adversarial. Take time to discuss the show with the reporter or producer prior to air time and find out as much as you can about what the host or interviewer hopes to accomplish. If appropriate, you may tactfully suggest additional areas or issues to be examined. Try to learn the biases of the interviewer and how much he/she knows about the subject. Reporters for these shows have usually done their homework and are capable of asking tough leading and followup questions. Try to anticipate as many questions as you can, then practice responses out loud or at least rehearse them in your mind. If possible, ask someone to play the part of the interviewer.
When time for the interview comes, listen carefully to the questions and, if you don't understand do not hesitate to ask the interviewer to rephrase it. When responding to questions, make eye contact with the interviewer. Looking around at what others on the set are doing makes you look shifty-eyed on camera. Keep your responses to the point and to ensure that a statement is used with a minimum of editing, keep it under 45 seconds in length. In the responses, you may use examples but keep them short. Numbers and other hard data may be included but shouldn't be overdone; listeners and viewers have a hard time absorbing facts and figures. Save the hard data for the newspaper interviews; on-camera impressions say more.
3. Talk shows - because of high public interest in the personal problems of everyday living and the problems of others, psychiatrists are frequently asked to appear as guests or even as hosts of talk shows. He or she is often selected because of general attractiveness, personality, and articulateness as well as for expertise in a given field. The guest is frequently asked to respond to questions from callers or members of a studio audience.
If you are asked to appear on this type of “call-in” show, you may ask the caller questions in order to obtain additional information that will help in suggesting referrals. Show concern for the caller and his or her problems. Have readily available a list of referral sources in the community and include in your responses the phrase “You may want to ask your family doctor for advice.” As a regular psychiatrist guest on a talk show you would probably work with the producer or host in selecting topics and would have ample time for preparation. Your responses should be kept short and interesting; do not belabor topics and points.
These type of shows often screen incoming calls to eliminate obviously disturbed persons and those using offensive language; and to ensure a variety of questions from persons likely to be interesting to the audience. Most persons call in good faith, expecting to speak with the doctor. Therefore, when possible, try to offer screeners a list of community sources for service and information to which callers not put on the air may be referred.
Whenever possible, emphasize that psychiatrists are physicians with special training in the differential diagnosis and treatment of mental disorders; that they are the only mental health professionals trained to handle medical problems involving both mind and body; and the only mental health professionals authorized to prescribe medication.
In all of your appearances and relations with the media, be sure that psychiatrists are identified as: “John Jones, M.D., psychiatrist,” not “Dr. John Jones, psychiatrist,” or “Dr. John Jones.” At all times try to avoid trivialization of the profession and mental illness, and emphasize that psychiatry is more than just helping people cope with the everyday stresses of living.
CAUTIONS TO REMEMBER • IT IS INAPPROPRIATE FOR PSYCHIATRISTS APPEARING ON RADIO AND/OR TELEVISION TO PROVIDE ANY ADVICE WHICH COULD BE CONSIDERED AS THERAPY TO A MEMBER OF THE STUDIO OR LISTENING AUDIENCE. PSYCHIATRISTS SHOULD NOT ATTEMPT TO STATE A DIAGNOSIS OR, IN ANY CONCLUSIVE WAY, DESCRIBE THE PROBLEM THAT MAY BE TROUBLING THE PERSON. THE PSYCHIATRIST MAY, HOWEVER, ASK THE CALLER QUESTIONS TO OBTAIN ADDITIONAL INFORMATION THAT COULD HELP IN SUGGESTING REFERRALS.
Example: A woman calls in asking for advice about fatigue and insomnia. Although the symptoms sound as if the caller probably is depressed, the psychiatrist says: “You must understand that I could not diagnose your problem without a very thorough evaluation. The symptoms you describe, however, are similar to those common for depression.” Then, rather than talk about the woman's problems, the psychiatrist talks about the nature of depression; explains how it is diagnosed, and describes available treatments. He/she then suggests to the woman that, if her symptoms persist, she should seek professional help and suggests several sources of such aid in the community, including the caller's own physician.
• THE PSYCHIATRIST MUST MAKE EVERY EFFORT TO PROTECT CONFIDENTIALITY AND MUST NOT USE CASE HISTORY INFORMATION EVEN IN A COMPOSITE WHICH COULD CAUSE A PATIENT OF THE DOCTOR TO BELIEVE REALISTICALLY HE OR SHE IS THE PERSON BEING DESCRIBED.
Example: A psychiatrist expert on agoraphobia is asked to appear on a television show to discuss the problem. The host asks the doctor to describe a typical case. The psychiatrist says: “To protect the privacy of my patients, I would prefer not to cite specific cases. In general, however, these patients share symptoms such as …” The psychiatrist then goes on to tell about the disease but stays away from individual cases.