IGNORING THE DOCTORS' ORDERS

Investigative Reporters and Editors, Inc. The IRE Journal, Winter 2009 by Eder, Steve

The survey, which took doctors about five minutes to complete, struck a nerve: We received hundreds of responses soon after the questionnaire was sent out in April. Because of the interest, we expanded it to include members of the American Medical Association in other states.

When we completed our survey late in the summer, we had a pool of 920 respondents from nearly all 50 states.

Overcoming challenges

The series took a great deal of shoe-leather reporting and posed a multitude of challenges.

Doctors have long been known for their reluctance to speak about their patients. Gently coaxing doctors to move beyond the generalities and share specific stories about patients was difficult, but doing the bulk of our interviews in person and spending several hours with our subjects helped us understand the roots of the problem.

We found doctors willing to contact their patients and ask them to share their stories with us. Once this patients signed on act/release waiver the dorctors should then discuss their cases. It was often a time-consuming task just to assure that a doctor could speak freely about a patient.

Before the story even ran, The Blade's survey drew the ire of the insurance industry in Ohio, which questioned its objectivity in a letter to top Blade editors. The newspaper, in advance of the survey, contacted an ethics expert with the Fbynter Institute to discuss the concerns of cooperating with an interest group in conducting a survey. The paper was told that the arrangement was ethically sound, as long as it was transparent with its sources and readers.

Before publication, Kelly McGivern, CEO of the Ohio Association of Health Plans, wrote the newspaper's top editors, questioning the decision to pair with OSMA and challenging the objectivity of the questionnaire. Ron Royhab, The Blade's executive editor and vice president, responded to McGivern in a letter, explaining that The Blade has not "committed in advance to telling a story from a single perspective."

Acknowledging the points made by the association, The Blade pressed on with the survey and assured the insurance industry that it would have an opportunity to respond before publication.

In total, the series was composed of four main stories and six sidebars. The sidebars gave us room to del ve into issues such as the growing concerns about the role of pharmacy benefit managers, defensive medicine and doctor ranking systems.

The series, designed and produced in the print edition by news editor Doug Koemer, included a display of graphics and photographs that helped readers understand the processes that must take place before treatment is approved by an insurance company - and the problems that ensue when insurers intercept treatment plans.

Blade photographer Jeremy Wadsworth spent months shooting the subjects of the story and focused his time on the patients we featured.

From the start, The Blade saw the series as an opportunity to push ourselves in terms of Web content. Web editors Kevin Cesarz and Kristi Young built a Flash presentation that incorporated all aspects of the investigation and included slideshows, videos, photo galleries, patient files and interactive maps, which included state-by-state results of questions from the survey. The series can be found online at www.toledoblade.com/healthcare.