Just last week some of my colleagues and I at Community News Service were chewing the fat over a classic journalistic challenge — what to include and what not to include when writing a news or feature article. We were responding specifically to what I thought was a terrific article in the September 14 New Yorker by the Princeton-based Pulitzer Prize winner, John McPhee. The article’s title: “Omission: Choosing what to leave out.”
Our discussion turned to the use of the first person in a feature. When does it make sense to use the first person “I” in a story, and when doesn’t it? When should that “I” be omitted from that story?
I wonder (pardon the pronoun). As the regular contributor of a column in this paper that relies heavily on that highly subjective, self-aggrandizing, and also somewhat unreliable character, I (the first and often the only person in my columns) may be more sympathetic to the first person than my colleagues.
One place where the first person comes in very handy is in medical reporting. I have used first-person experiences to report on area hospitals’ cardiac care capabilities. The occasion of my walking into Mercer Medical Center in Trenton for a routine test and being carted off in an ambulance to St. Mary Medical Center for the installation of a stent in a 90 percent blocked artery was the grist for a lengthy article in U.S. 1’s June 19, 2002, health and fitness issue.
I followed it up with several more first-person columns on the challenges of deciding when to report — or not report — aches and pains to doctors. As those columns were written several people I knew — some who had read my columns — died of heart attacks. No first person story for them. Hopefully a few others began taking note of their own aches and pains and sought care.
Just this week, I stopped by a book signing for the Princeton mathematician John H. Conway, and was introduced to a couple whose son had participated in a program with Conway years ago. The wife recognized my name and immediately referred to that column on clogged arteries published more than 13 years ago. She had made her husband read it to increase his medical self-awareness.
A few years ago, on the eve of an event to raise awareness of prostate cancer and to encourage men to have prostate exams, I wrote a first person column on a cystoscopy I had just undergone to determine the cause of a trace amount of blood found in my urine. Basically I was saying “Hey, you big guys who are squeamish about routine digital rectal exams to detect prostate cancer, if little old me can undergo a cysto (you can check the Internet for details) then you can surely stand up to an exam that often leads to early detection and total cures.”
That column, more than most, demonstrated to me the power of first person reporting. In this day of HIPAA and all sorts of patient privacy rights, what doctor would give up the name of a patient who had undergone a cystoscopy? What patient would agree to comment on their procedure?
Most recently I wrote a first person account of my knee replacement surgery by Dr. Thomas Gutowski in January of 2014. It was an ideal subject for a feature story to anchor our health and fitness issue in June of that year, and it was a subject that many of our baby boom readers were addressing. As has been the case with other first-person articles relating to medical events, some readers always want more. Just last week I received an E-mail from a reader who has a knee replacement scheduled in a few months and was seeking more information on the Internet. The reader found my column and wanted to know more — see sidebar, page 43.
Turns out that patients speaking up — to their doctors and with other patients — are not lost on the community of healthcare providers. One central New Jersey area start-up, VoxTelehealth, aims to facilitate post-operative communication between caregivers and patients with an Internet-based application.
As U.S. 1’s Barbara Fox reported in a sidebar to my story on June 25, 2014: “Aiming to redefine the process of patient recovery, the company delivers procedure-specific patient education and recovery programs on a web-based platform. By engaging the patient every day, these programs help patients both before and after an operation.”
The VoxTelehealth system provides home care instructions and enables patients to track their progress. “Certain responses, such as an unacceptable pain level, will trigger a call from the nurse, who might schedule an office visit for you the next day.”
Fox did a little more Internet sleuthing when I mentioned this column to her and uncovered a slew of other websites where doctors and patients can interact with each other. Among them:
HealthLoop, which automates follow-up care and keeps doctors, patients, and caregivers connected between visits; My Knee Guide, which includes a Twitter feed; Bone Smart, which calls itself “the world’s largest joint replacement community with sections for pre-op knee, post op knee, plus a lot of other surgeries;” and Creaky Joints, part of the nonprofit Global Healthy Living Foundation, a free patient community sponsored by four medical schools and nine pharma companies, including Janssen and Bristol-Myers Squibb.
Others include Care to the People, which lists online support groups, blogs, and interpatient connections; and epatientfinder.-com, a healthcare technology company with a mission “to make patients aware of all their treatment options” and “empower physicians to learn about cutting-edge treatments and educate their patients on their treatment options.”
Getting patients more involved in the healthcare process now has a buzzword to describe it: “participatory medicine.” The movement is supported by the Journal of Participatory Medicine, published by the nonprofit Society for Participatory Medicine (www.participatorymedicine.org).
One article was written by Kate Lorig, a medical doctor who is also an active participant in the healthcare system as a patient. “I was born with a rare genetic disease. In my six-plus decades of life I have acquired a few more chronic conditions and am still thriving, even after treatments for cancer. I experience an average of 30 or more encounters with the health care system each year and half that number with my insurers. In addition, during my academic career I have helped thousands of people participate in their care through the development of the Chronic Disease Self-Management Program, and I have learned much from their stories,” writes Lorig, director of the Stanford Patient Education Research Center.
“Of course, as patients, we always participate,” Lorig continues. “We have no choice. Rather, our participation styles differ. Some of us actively seek out knowledge, research our providers, and question their treatment recommendations. Some comply carefully to all recommendations from our providers. Some of us embrace lifestyle changes, some of us struggle with them, and some of us find them impossible.”
To me, that’s the beauty of people (journalists included) sharing their experiences as patients. The doctors’ role is usually pretty clear. Our role is unscripted and highly variable depending on who we are.
The “I” character deserves special scrutiny. The first person narrator enjoys an easier ride than a source being quoted by a reporter. The quotations attributed to that source can be compared to other statements made to other reporters. The first person, on the other hand, operates in a world of his or her own. Who can argue with the accuracy of quotations from a guy named “I”?
In the course of writing these first person participatory medicine articles, I have received lots of input from others who have “participated” in the healthcare system. Without diminishing what they went through, I did come to a realization — that we should be very skeptical of anyone’s personal testimony about his or her experiences during and after a medical procedure. Anesthesia does not lead to accurate reporting.
But that doesn’t mean we should abandon the format. In the Journal of Participatory Medicine, Kate Lorig quoted the editor of Medical Self-Care Magazine, Thomas Ferguson MD: “Doctors would get off their pedestals when patients got off their knees.” Concludes Lorig: “Participation means that we as patients, we as providers, and we as health care system managers must be willing to acknowledge our interdependence and meet on a level, if changing environment. To do otherwise is dangerous and will lead to poor outcomes.”
So I say (there I go again) that in journalism, as in healthcare, there are times when we reporters need to stand up, drop the third person veil, and make ourselves part of the story.