Helping doctors put patients first: an innovative service from health libraries

The lay public's interest in scientific topics, particularly anything concerning health, medicine and drugs, is growing continuously throughout the world.1 The huge variety of information sources available, including the Internet, has meant that patients now tend to be more informed and motivated and take a much more active role in their health care. The impact of the wealth of information spread by the mass media and available on the Web is clear. It influences not only individual health behaviour, but also health-care utilization and health policies.2 Doctors are finding that well-informed patients who understand the nature of their illness and its treatment are likely to get well faster and have a better quality of life, and the empowerment of patients is a dominant feature shaping their relationship with health providers.3 According to the international literature, people obtain more health information from magazines and newspapers than from any other source, even their doctors. In Europe, citizens’ sources of information on health are the television, school, scientific journals and the press.4 Italy has seen a steady increase in the numbers of lay periodicals devoting space to medicine and those specialized or fully dedicated to health and well-being. The popularity of news on topics related to health and quality of life is second only to sports news. Some television programmes on health and medicine boast average audiences never less than 246 000, with prime-time peaks of two million and more.5 Like medication, information carries risks as well as benefits. Where there is information there is also misinformation; coverage may be inaccurate or over-enthusiastic, as concluded by the first systematic content analysis of a random sample of news articles on specific drugs.6 Responsible reporting by journalists can illuminate important issues for the general public that might have remained buried in the scientific arena. However, results that are misinterpreted, misrepresented or both can generate confusion and panic in the general population.7 Doctors want to have time to evaluate any important report and see it in context, and they are never comfortable with basing clinical advice on the reports as a news media.8 However, physicians too rely in part on the media to learn about new studies, especially those outside their specialty areas. Physicians also want to see the news that their patients are seeing.8 Unpublished evidence collected by this Centre indicates that, in Italy, the number of news items on medicine appearing in the four most widely read daily newspapers and their supplements in May 2002 totalled over 400, more than half making reference to a scientific publication or congress. However, Italians are not undiscerning consumers of this information: some 30% consider that the media are confusing, giving information that is too vague, and 18% believe that the information is likely to be biased by conflicts of interest. For information on diseases, if the disease is very severe the doctor's role is still unchallenged (94%), compared with that of the media. (4%). Even for minor complaints the doctor still holds first place (66%), ahead of the media (16%).9 Well aware of this interest, the media devote ample space to articles on health, medicine and welfare. In Italy, the more public interest for health-related issues has grown, the more competent journalists have dropped out of the scene. In the 1980s and 1990s an editorial office was organized with a group of senior editors and dozens of journalists, the so-called ‘specialists’, who specialized in one particular segment of society and presented its tensions, interests and problems. With the advent of new technologies and the telematics revolution, this large group of journalists has split into two: there are the assistant senior editors and the ‘news-desk’ people (sub-editors who ‘pick out’ news items from press agencies and adapt them to the space available), handling only secondary information, which in most cases is produced outside the editorial offices. In the early 1980s, editorial offices received 400–500 news items a day on average. Nowadays, they are likely to get 6000–7000 items, a 10-fold increase compared with 20 years ago. Media managers are obliged to make a large number of decisions every day. Pages are edited and changed in the space of a few minutes, chasing the latest interesting item in the uninterrupted spate of information landing on their desks. This inflation has had a price: the number of specialist editors in any editorial office has dropped. Experience is confined to supplements, which tend to separate actual competence from the ‘news factory’.10 Consequently the choice of articles appearing in the mass media is not based on a precise agenda for citizens’ health, but is affected by the whole body of facts/news issued by the press agencies, by the nature of a fact as ‘news’, by the choices made by the editorial staff meeting assembling the issue, and journalists’ ability to defend their pieces so they find room in the current issue. Even a normal fact can become news: an event becomes news when it is somehow unusual or peculiar. There are seven basic categories of media events that have news value and can be written up as newsworthy11: an unusual or peculiar event (a dog biting a man), even in relation to the target (a man marrying four women might make the news in Europe, but not in an Arab Emirate); something with practical implications in everyday life (the advent of the Euro currency); an item with potential consequences for everyday life and everybody's interests (weather forecast); an event with physical and psychological proximity (something happening in our own nation strikes us more than a similar event in a distant country); an item that arouses emotions and creates expectation (news on medical advances belong to this category); exclusive and timely items. There are three other broad areas for media events12: human interest (solidarity and charity, love of children or animals); progress, particularly advances referring to science, medicine, or general culture, such as space exploration, discoveries of drugs, etc.); social prominence when the actors are VIPs or come from important countries (the same news has different weight if it comes from a powerful nation or an undeveloped or remote country). Journalism aims to inform, educate and give pleasure. These three components are applied in different proportions in relation to the target and the editorial policy of each publication. Even if the concept of ‘giving pleasure’ is sometimes applied in health campaigns to help people remember ‘messages’, doctors’ aims are in fact restricted to informing and educating. From the international literature and a survey of medical journalists in 37 countries, through focus groups, several barriers have been identified in correct communication to improve the informative and educational value of medical journalism13: lack of time; space and knowledge; competition for space and audience; difficulties with terminology; problem finding and using sources; problems with editors and commercialization. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of experience and media. Moreover, many health reporters have difficulty finding independent experts willing to give them time, and editors need more education in critically assessing medical news. Whereas the world of science still attaches great weight to the authority of the source, which is quantified using objective criteria based on the numbers of citations, and presented as an ‘impact factor’,14 journalism has no such clear criteria. A Swedish study in which 110 scientific journalists were asked to specify their main indicators of professional quality found that sources of information were ranked third, after respect for facts and a sense of professional responsibility.15 Scientific reporting could be improved by extending to information sources the concepts of the new ‘precision journalism’, an approach that holds that scientific methods should be extrapolated to journalism.16 There are several fundamental points that a good scientific journalist, like any scientist, must know: how to find the latest information (the sources), how to assess it (quality and authoritativeness, preliminary results), how to analyse and filter it (selection), how to use it best (without extrapolation of the results), how to render it accessible and useful to the general public (dissemination), and how to deal with information biased by conflict of interest. The information provided by the mass media distorts the interaction between doctor and patient, by focusing on the ‘news’ aspect more than on necessary diagnostic and therapeutic decisions. Any tool that helps doctors set up a correct relationship is welcome. As a centre for studies on drug communication, we have been asked to design an alerting service for general practitioners on health and medical news published in the lay press. The preliminary project involves scanning the top newspapers and their medical supplements, and the main women's magazines every day, for a total of six newspapers, three medical supplements and four women's magazines. Topics will be selected for their importance and clinical implications and structured under empirically selected headings and therapeutic areas. Doctors will receive an e-mail alert including the following for each selected article: newspaper or magazine publishing the news; descriptive titles, titles implying the results; indicative abstracts; information on the original publication or congress (references and links to newspaper articles and scientific papers, when available); any indication of potential conflict of interest. On request, full texts of the news and scientific papers cited will be provided. In designing our project, we have based our calculation efforts on our experience deriving from a pilot project carried out on the four main national newspapers and intended to monitor the trend of health news in the national press. We have considered some of the major national newspapers (Corriere della Sera, La Stampa, La Repubblica, Il Giornale) and their three supplements on science and/or health (Corriere Salute, Salute di Repubblica, Tutto Scienze e Tecnologia-TST). Between 2002 and 2004, in a sample period, we have identified a total of 420, 450 and 305 news items monthly. For our files, we shall record the main features of the news item: the position of the article (first page, second page, etc.); the position of the article on the page (left, right, top, bottom, etc.); numbers of columns and length, continued on page … ; interviews, scientific articles cited, explanatory boxes, glossaries. Iconography, graphics and other details are recorded for internal statistical reasons. In our opinion, this news alert could be integrated into the portfolio of the added-value services delivered by health libraries, replacing or integrating traditional services that in certain settings may be becoming obsolete with the advent of new technologies. Our project can be easily implemented with attention to three critical areas. First, the design of a broad classification suitable to collect all the subjects dealt with by the press considered, which could allow to have subcategories for specific items for specific and seasonal subjects (such as SARS, pandemic influenza, etc.). To solve this issue, an approach could be to define the classification after a short test. A few papers are published in literature on the quality of medical journalistic articles, but there is no publication on how to classify them. Second, all the aspects relating to the main features of the news items (such as the position in the newspaper or magazine, number of columns, etc.) can be interesting only if the service supplier is specializing in media communication. Finally, while it is easy to identify the articles of interest, scanning and reading the material can be rather time-consuming and is not easily forecast. In our experience, the time requested varies considerably among operators, as a result of scientific background and culture and personal skills. However, during our pilot project, all the operators improved their capacity of scanning and reading, reducing the time necessary to identify, choose and classify articles. In the absence of other published quantitative evidence for Italy and other countries, we are provided with figures just as an indication of the workload. As a marginal note, 60% of articles referred to the original source (main scientific journals, health authorities and other renowned institutions). In 2004, the main topics were related to psychiatry and psychology, cardiology and cardiovascular diseases, infectious diseases, gynaecology and assisted fertilization for newspapers; nutrition and oncology are the key subjects in inserts. This alert service has been designed for doctors, but could be useful for patients too if the news item is commented on with an indication of its clinical relevance. The idea of this project could be extended to other media such as radio and TV programming; obviously this implies that the necessary facilities must be available—recording of programmes, etc.—and adequate resources and logistics, which are still rather unusual for a typical medical library. Implications for Policy An innovative and interesting addition to the portfolio of products and services of health libraries. An example of diversification of library services. An enhanced visibility for libraries. A useful service for doctors, helping them to get closer to their patients, grasp their approach to medicine and whenever necessary correct it. Implications for Practice Skills of librarians in health libraries are adequate to provide this service. An accurate evaluation of resources involved is required. The supply of the service through e-mail messages is simple, inexpensive and not greatly time-consuming.

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