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'Surgeon in the crosshairs'

Article-'Surgeon in the crosshairs'

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  • When their reputations are on the line, how should physicians respond to the media? In some cases their hands are tied

Apparently I was the only person in America who did not know who Kanye West was until news broke on November 12th. But CNN, Fox News and E! set me straight. For those of you still hiding under rocks or returning from a trip to Antarctica, here is what the country heard. The mother of a famous rapper had two plastic surgical procedures and she died. Ms. West's surgeon, Dr. Jan Adams, accepted an invitation to "tell his story" on Larry King, and my thoughts are limited to that decision.

MEMBERS ONLY To be sure, Dr. Adams was being judged in the press, and his entire career was put under a magnifying glass. News pundit "analysis" was often without context or explanation — just a hodgepodge of data. To start, he allegedly had been sued for medical malpractice. Join the club. At any given moment there are approximately 60,000 open medical malpractice cases affecting just over 700,000 physicians. Further, the National Practitioner Data Bank includes the names of over 200,000 healthcare professionals who have not only been sued, but have paid a settlement or judgment. So, being sued is hardly an indictment of incompetence, although the media would have you believe otherwise. Next, there were other issues related to brushes with the law. Those are harder to explain away.

Make no mistake, the media was looking for a story and Dr. Adams was in the crosshairs. Seasoned PR veterans talk about cardinal rules of managing a crisis: When a story breaks, there is a "golden hour" where you can control the message. To remain credible, the messenger must be willing to "tell the truth, tell it all, tell it fast." This certainly worked for Johnson & Johnson when their beloved Tylenol brand was paired with cyanide. Enron, following a different strategy, did not fare as well. Levick Strategic Communications, a brand strategy consulting firm, imparts wisdom from Machiavelli: "Good news over time, bad news all at once."

When their reputations are on the line, what can physicians do with the media? In some sense, their hands are tied. Both HIPAA and state confidentiality laws prevent a public airing of the details of a case unless the patient (or representative) consents, or unless a lawsuit is filed. When a patient sues a doctor, he is prevented from using the medical record as either a sword or a shield. And even then, not all details can be revealed. For example, if the patient has a psychiatric history, a problem with substance abuse or HIV, a doctor defendant in a run of the mill negligence case is forbidden from delivering those details unless they are directly relevant to the dispute.

ASK NOT FOR WHOM THE PRIVACY RULES Hipaa applies to most physicians, particularly those who file claims electronically with insurance carriers. there is an exception. Karen Trudel, director of hipaa projects for centers for Medicaid and Medicare services once stated, "it bears repeating that the privacy rule applies only to covered entities. The proverbial country doctor who deals only in paper, or who has a computer but conducts none of the transactions referred to in section 1173(a) electronically, would not be a covered entity and would not be subject to this legislation." Hence, a physician who has a cash-only business might be able to sidestep HIPAA. That said, it might be difficult to bridge the gap between "the proverbial country doctor" and a Beverly Hills plastic surgeon. HIPAA is a federal mandate, and even if sidestepped, there remain state confidentiality laws that must be followed. And, since privacy is viewed as a fundamental ingredient of the doctor-patient relationship, the Board of Medicine and specialty societies view willful breaches of confidentiality as ethical lapses subject to discipline.

MESSAGE DILUTION Above and beyond the specifics of the case, there are certainly many subjects that would be fair game for a chat on Larry King Live. These might include the dangers of general anesthesia, the risks of the specific procedures, managing unrealistic expectations, and the like. But it is difficult for the surgeon in the crosshairs to serve as an effective messenger for that message. Unless pulled off adroitly, it would come off as little more than self-serving. And the important message would be diluted, feeding the media circus.

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