Framing and Bias: Health Care Lessons for the Reporters At National Public Radio (NPR)

Now THAT's framing!

So, is the kerfuffle over National Public Radio (NPR) the long delayed comeuppance for liberal bias run amok, or a narrow-minded attack on the inconvenient truths from journalistic excellence? 

To answer this question, the Disease Management Care Blog reached into the parallel universe of medicine.

Imagine being a physician who is caring for a patient who has just been diagnosed with a life threatening illness such as cancer. You know the patient has a right to self-determination and should be told of all the treatment alternatives, benefits and risks.  You take the time, you explain and maybe even "coach," but even if the decision-making is "shared," your job is to help the patient chose the best option. 

Case closed, right?

Now imagine being a news editor with the responsibility of broadcasting an in-depth report about a major news story.  You know your audience has a right to make up their own minds after the classic "who, what, where, why and when" are objectively presented.  You also take the time, you explain and sometimes paraphrase, but your job is to communicate the facts and nothing but the facts so that your audience is informed. 

Case closed, right?

You'd probably be wrong on both accounts. 

For more insight on how physicians discuss "facts" with their patients, check out this decades-old paper that demonstrates how health experts' and lay persons' treatment choices can be significantly influenced by how clinical information is "framed."  Subsequent research has confirmed that the method used by doctors to present nominally objective facts can have a huge impact on patient decision-making - so much so, that there are published recommendations on how to best communicate information for optimum patient-decision making.  That's important, because research has also shown that physicians can intentionally manipulate framing if they believe it is in the patient's best interest.  More importantly, significant framing can also be unintentional. 

While the topic of biased decision-making can be even more complicated, the point is that if you examine how many physicians approach informed decision-making, they'll be genuinely surprised at the prevalence and the impact of framing.  While it's fashionable for health reform advocates to blame economic self-interest on the part of docs, the data show that physician motivations in choosing the "red pill" versus the "blue pill" are far more subtle and tangled than generally appreciated.

Which is why the physician Disease Management Care Blog feels the pain of news editors everywhere. That is especially true for the folks at National Public Radio (NPR), who are being scrutinized for their allegedly biased reporting.  The real issue, says the DMCB, isn't the tawdry numbskullness of NPR's execs, but a growing realization that reporters - just like physicians - may also be prone to conscious and unconscious framing.  And just like physicians, they're probably genuinely unaware of how common and powerful it can be.

Will physician payment reform including "bundled" and "two-sided payments" be enough to change this aspect of physician behavior?  The DMCB doubts it.  Better for docs to be aware of the existence of framing and use emerging approaches like this to minimize its impact in shared decision making. 

As for NPR, the DMCB is still a loyal listener.  There may be lessons for NPR in the medical literature, starting with simple awareness of the potential impact of framing on its listeners.  Gives whole new meaning to the term....

Stay tuned!

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