Try everything. In my early flailing days I looked at chat rooms. But many patient groups are financed by Pharma. If you go to a chat room sponsored by Astra Zeneca, you end up getting an inhaler so that sample was biased, and it’s hard to find patients’ real names and contacts. I looked everywhere, including standing in a parking lot of a physical therapy office looking for patients in a town in Pennsylvania that seems to have PT practices in every shopping mall. PT can be very lucrative these days because there’s a lot of self-referral by docs. But it was a cold day and I didn’t find a willing candidate or at least not one who would have carried the entire story.
Any other social media successes?
For the story about the high price of stitches to sew up pretty routine cuts, I used The New York Times Facebook page asking if anyone had experience with high-prices for minor medical procedures. The first attempt did not get much response. The second one did. That’s why I say the gods of reporting were with me. It was partly fortuitous and partly casting a large net.
Besides finding the right person to carry the story, what else do you do to prepare?
I read a lot. I can’t imagine not reading. I do MEDLINE searches [The US National Library of Medicine’s medical journal database] on everything. It’s important to know who’s writing what in the field. Medical journals make it easy for me. I don’t know what I would do without a MEDLINE search. It gives me a framework for the story. I go through the papers in the journals to see who’s doing interesting work. That means you don’t have to go back to the same source twice. That enables me to sort out whether what I am hearing is a function of the expert I happen to call. There’s also a lot of trade literature about the business of healthcare.
As time went on, did the responses you got help you refine your methods for subsequent pieces?
The first piece in the series on colonoscopies generated more than 10,000 comments. We knew we had touched a nerve. We learned a lot from the comments. I felt as the series went on, reading the comments was sometimes even better than reading the story. It got me thinking about the next issue I needed to report on—or something I might have missed. That’s why we started doing follow-up stories.
What specifically did you learn?
For reader engagement, we learned how to frame questions to get longer and more thoughtful responses. We found some questions were not good to ask. You have to ask what you want to know and what people really know. If we asked, “How much should a hip replacement cost,” how would they know? You won’t get a smart answer to that. But ask, “If you’ve had a recent surgery, what aspects of the bill surprised you,” you’ll get a treasure trove of responses.
What’s an example of a bad question?
At the beginning of the Pharma story, we asked, “Is there a drug you cannot afford?” That wasn’t such a good question because it led to one-word answers, and since it was the very beginning of a long story on asthma inhalers, more than 95 percent of respondents complained about that. The response wasn’t enlightening or engaging either.
Was the series a local or a national story?
I felt strongly I didn’t want this to be about one hospital or one doctor. The idea was not to produce a local story but an economic one that applied across the country. The same problems found at one hospital in California are typical of others in the state and everywhere else.
What’s been the response from the medical establishment?
Healthcare money has infiltrated the healthcare system, and that’s not good for patients. There’s pressure from hospitals and insurers not to have a different kind of payment system. There’s been pushback on every story especially from the health systems’ people whose doctors were spotlighted. They want to know why. The answer is bad luck. Patients like their care but don’t like the cost.
Does any group stand out as being particularly aggressive in pushing back?