Why investigate one patient's charges?

A feature in health care journalism is the deep dive into medical bills. With the series Bill of the Month, NPR and Kaiser Health News regularly investigate specific bills to shed light on the costs of care in the United States. This type of consumer advocacy is most effective when the bill in question exposes common problems.

One reader objected to a recent Bill of the Month story, concerned that drawing attention to a high colonoscopy bill will deter others from getting their screening tests.

Raising that concern is really raising a question about journalistic purpose. Bill of the Month was not designed to educate people about getting their recommended cancer screenings.

Medical bill investigations are about accountability. That's because paying for medical care in the U.S. means navigating a Byzantine and opaque system. It's often difficult for the average consumer to cut through the bureaucracy to arrive at a clear understanding of the money owed after a medical treatment.

This gap between the reader's concern and the story's intent exposes a common shortcoming in the news. Journalists rarely tell their audience what the purpose of a story is. Mostly they assume that the story itself makes their intention clear.

Bill of the Month is an exception. NPR does explain the purpose of the series: "Journalists from Kaiser Health News and NPR will be looking at surprising medical bills and figuring out what they can tell us about the health care system."

And when this particular story aired on All Things Considered, the host introduced it by telling listeners that colonoscopies are mostly free, and that if Bill of the Month is looking into one, then "something is not going as it should in our health care system."

Read on to learn more about Bill of the Month's purpose.

We have two additional audience inquiries about the specific words and phrases that journalists use when covering the polarizing issues of gun policies and abortion access.

Finally, we spotlight a recent episode of It's Been A Minute that explores a curious trend in entertainment.

FROM THE INBOX

Here are a few quotes from the Public Editor's inbox that resonated with us. Letters are edited for length and clarity. You can share your questions and concerns with us through the NPR Contact page.

A discouraging headline and article?

Jody Hoyos, president of the Prevent Cancer Foundation, wrote on June 13: Michelle Andrews' recent article, "Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?" raises critical issues with hospital billing codes and educates readers about the "No Surprises Act." Our concern is that it will also discourage Americans from getting the annual health screenings that could save their lives.

... Readers may not scroll through 25 paragraphs to find that the $2,185 bill was due to a coding error and Elizabeth Melville owed nothing for her colonoscopy.

The article also misses the opportunity to educate readers on basic insurance coverage, what they need to ask before scheduling their colonoscopy or that other non-invasive screening options, like Cologuard, are readily available in the market with no additional cost to patients.

Early detection is the most important thing people can do to stay healthy. Everyone must feel empowered in navigating screening options. ...

We hope future headlines will focus on, "Early Detection Will Save Your Life - What You Need to Know About Cancer Screenings," to encourage everyone to get their routine screenings back on the books.

This story was published under Bill of the Month, a crowdsourced investigation by Kaiser Health News (KHN) and NPR that dissects and explains medical bills. The story explored New Hampshire ski instructor Elizabeth Melville's colonoscopy bill, and provided helpful information on talking to insurance companies before an exam.

Diane Webber, KHN's national editor for broadcast, oversees the partnership and assigns reporters to the coverage.

"We use it to try to illuminate different financial pitfalls of our complex health care system," she said.

She wrote the headline in question, which appeared on KHN's website. The story is also featured on NPR.org under a different headline written by Carmel Wroth, an NPR Science Desk senior editor: "Cancer screenings like colonoscopies are supposed to be free. Hers cost $2,185."

Webber told me Melville's colonoscopy bill was chosen because everyone over 45 years of age, in consultation with their doctor, should get screened for colon cancer. Her team has received letters from people who experienced scenarios similar to Melville's.

"We think this is a really widespread problem, and that a lot of hospitals are charging people for colonoscopies after they find something," she said. "And the government has done no enforcement of making sure preventive care is free when it should be free. It's a dramatic headline and we want people to click on the story and understand what their rights are."

To Webber, this KHN headline shows an example of a woman who got her important diagnostic tests as directed by her doctor.

Webber emphasized that this is an accountability story. "If you get a big bill after a screening colonoscopy, and you have employer-sponsored insurance, there's a high likelihood that your hospital system is not following the rules," she said. "So we want other people in her position to know that they have a very good argument to fight that big bill."

"It is not a story about the public health importance of people getting a colonoscopy, though we certainly recognize the public health importance of getting a colonoscopy," she said. "The story was about giving people the tools to get this test paid for properly."

She also noted that the article does include information about the lifesaving significance of screenings. For example, the story cited a 2020 analysis of published studies stating that "screening colonoscopies reduce the relative risk of getting colorectal cancer by 52% and the risk of dying from it by 62%."

We often get comments from readers and listeners who are upset that a story and its headline didn't deliver the message they were hoping for. When medical facilities unfairly bill for diagnostic procedures, people are discouraged from seeking recommended tests. Holding the doctors' offices and insurance companies accountable for this is the best way to fix the problem, not minimizing the fact that it happens.

Bill of the Month's findings aim to help other readers navigate the U.S. health care system should they ever encounter the same issue. This story, and its multiple headlines, fulfilled that purpose. — Amaris Castillo

Why does NPR use the term 'abortion care'?

Gwendolyn Barlow wrote on May 26: Could you please explain the frequent use of the phrase "abortion care?" When covering other medical procedures, do your reporters exercise consistency by referring to "appendectomy care," "chemotherapy care," and "coronary bypass care?" Or does abortion alone enjoy this elevated status as a procedure with "care" added to it?

... In the interests of journalistic integrity, please consider more neutral language.

Journalists often follow specific style guides, such as the Associated Press Stylebook, and also general language conventions when deciding which terms to use. AP and NPR do not address the term "abortion care" in their guidance to journalists.

We asked a few NPR journalists to weigh in on the use of "abortion care" in reporting:

Sarah McCammon, a National Desk correspondent who regularly covers reproductive issues, told us she tends not to use the term to be succinct. But sometimes sources may use it when being directly quoted.

Scott Hensley, senior health editor on the Science Desk, said: "An abortion is a form of medical care and involves more than the procedure itself. Our reporting often includes this language as context."

Tony Cavin, managing editor for standards and practices, said: "I think the term 'abortion care' is appropriate in certain circumstances where we are discussing more than just the procedure itself. NPR's reporters and editors are knowledgeable and I trust them to use their judgment as to when the term might be appropriate."

"Care" is often attached to areas of medicine, including "cancer care" and " dental care," both terms that NPR has used in its reporting. Journalists also use the widely applied general terms "health care" and "medical care."

The term "care" may also be attached to these medical areas because they involve more than one type of procedure or treatment, as Hensley and Cavin mentioned. Multiple abortion procedures can fall under "abortion care," just as multiple dental treatments can fall under "dental care." The difference is that the former is more often politicized, but still a part of medical practice.

"Abortion care" seems to be used by NPR because of its precision and not because it is meant to sway the audience. — Emily Barske

'Gun control' or 'gun safety'?

Catherine Fenollosa wrote on June 6: There were two stories on ME this morning about the gun debate. Both mentioned "gun control" several times. I'm curious why it's not referred to as "gun safety?" It seems to me that media outlets have adopted the NRA's language on the conversation much like pro-life was referred to for many years instead of the more appropriate anti-abortion. (I am a former employee of WBUR.)

Other NPR audience members have suggested that "gun safety" is the more accurate term. In a newsletter last year, we addressed an audience member who suggested language like "gun violence prevention" or "harm reduction" were better terms than "gun control."

NPR's Style Guide has no entries for coverage on guns or any other weapons. And the AP Stylebook has guidelines on the correct language to describe guns, but doesn't list specific preferences for talking about gun legislation or safety measures.

NPR Managing Editor for Standards and Practices Tony Cavin said NPR hasn't issued specific advice to its journalists on the term "gun control."

"With questions about gun legislation, as with anything else, NPR tries to use the clearest and most accurate language to describe things," he said via email. "Gun control, like narcotics control or air traffic control, describes government efforts to regulate a situation. It has been used for many years [in] proposals to regulate the sale, use and possession of firearms. Gun safety is the stated aim of some of those measures."

He said both terms — "gun control" and "gun safety" — seem to be accurate descriptions of the various legislative proposals that are being made.

Even without formal guidance, NPR journalists are using both of those terms to describe the current debate, as well as some other phrases. In one of the June 6 Morning Edition stories referenced, host Leila Fadel used the term "gun control proposals." On the same show on June 13, host Rachel Martin used the term "gun safety proposals."

NPR is using the terms appropriately, although neither term is perfect or precise. As we articulated when addressing this a few months ago, the Public Editor's Office continues to be an advocate for specificity and clarity over brevity. "Gun violence prevention," as suggested by the audience member in last year's newsletter, is another good option for NPR to use from time to time.

As gun policy debates continue in the U.S., it's time for NPR and the AP to issue specific guidelines so journalists can ensure that their language is informing the debate rather than tilting the scales. When the news media use accurate, clear and neutral language, we can better serve the public. — Emily Barske

SPOTLIGHT ON

The Public Editor spends a lot of time examining moments where NPR fell short. Yet we also learn a lot about NPR by looking at work that we find to be compelling and excellent journalism. Here we share a line or two about the pieces where NPR shines.

The parental apology fantasy

It's Been A Minute delivered a fascinating conversation about a recent trend in on-screen storytelling: the "millennial parental apology fantasy." These portrayals of parents and children in conflict span a variety of genres, including animation (Encanto), the big screen (Everything Everywhere All At Once) and TV series (Ms. Marvel). Guest host B.A. Parker spoke to Vox Entertainment Critic Emily St. James, who explained that core to this fantasy is "a bad parent who apologizes eventually, and that apology kind of fixes everything" in the story. The discussion can provoke deeper thinking about just how much trauma parents potentially inflict on their children. — Amaris Castillo

The Office of the Public Editor is a team. Editor Kayla Randall and reporters Amaris Castillo and Emily Barske make this newsletter possible. Illustrations are by Carlos Carmonamedina. We are still reading all of your messages on Facebook, Twitter and from our inbox. As always, keep them coming.

Kelly McBrideNPR Public EditorChair, Craig Newmark Center for Ethics & Leadership at the Poynter Institute [Copyright 2022 NPR]