Our PBS Documentaries

> Frontline: Dr. Solomon's Dilemma

Press / Viewer Reaction

Sample responses from e-mail, phone, web site chat room, especially highlighting comments of program participants, health specialists and programmers, and patients:

Dr. Alan Moses, Medical Director Joslin Center for Diabetes: "You hit all the right notes in the program. The issues you raised will, we hope, start a debate along the very lines that need to be debated. We have a system in meltdown. I would be happy to participate in any debate generated by the program. The choice of characters was really key. Risa Dinman-Lavelle, the young woman with diabetes, is the perfect example of someone who looks well but has to maintain a really strict regimen in order to stay well. That is something that people don't get and you made it crystal clear."

Dr. Andrew Brotman, Vice Dean NYU School of Medicine: "Great job on the program. You took something that is incredibly complex and made it interesting. It isn't easy to get that scene right - with all the different personalities and conflicting agendas - but you guys did it. As someone who was around there for a long time, I can tell you it rang true."

Dr. Herb Kressel, President, Beth Israel Deaconess Medical Center, relieved during production: "You are great at what you do. I was amazed at your ability to take a complex issue and lay it bare. I think because of your show, people will begin to understand what they are signing up for in managed care programs, and the effect it ha son physicians and patients. I hope that this is effective in stimulating meaningful dialog on what we want from our healthcare system, and how to achieve it."

Dr. Jim Reinertsen, CEO, CareGroup and Beth Israel Deaconess Medical Center:"Somewhat to my surprise, most of the feedback I have received has been positive: honest, courageous, informative, admire the institution for taking the risk, etc. My personal reaction has been somewhat different. I'm still trying to sort out why I feel this way, but I am angry about being portrayed as the heavy in this story. My read of it is that you used a popular journalistic device - I'll call it "Erin Brackovitch" - to pit the powerless good guy against the evil big organization, usually personified by a man in a suit. I was not aware during any part of our interview that I was being set up to be that man in the suit, and I must admit it doesn't feel good.

"As journalism, it worked well, and I congratulate you for that. And it got the point across. What's ironic, and what feels bad to me, is that most of my career has been spent trying to remove the sorts of dilemmas faced by Dr. Solomon, and had you asked me, I could have pointed out some very interesting ways to deal with those dilemmas. What's even more ironic is that the system of pods, information feedback, and MD-led management of care at CareGroup was chosen and designed by the doctors themselves, long before I arrived on the scene.

"I am going to continue to work to preserve the mission of this great institution. I will be working today with a few less hours of sleep and with some unknown number of my staff who have gained the impression through this documentary that their CEO does not care about the mission, only about the money. Admittedly that's a personal issue - but since I'm the CEO, it becomes something of an institutional issue, because it diminishes my effectiveness as a leader. Only time will tell whether that diminished effectiveness will be trivial, or significant. In the meantime, I'll take my own advice - I'll get over it."

J. Anthony Schwartz-Lloyd, Former Director of Communications, CareGroup, now its media consultant: "It was, for me, an extraordinary learning experience to work with you, Hedrick, and with David and Tom. Actually most of the buzz that I have heard has been positive to enthusiastic. I think many people are absorbing it as you intended: to broaden discourse and understanding of very difficult human and societal issues. Personally, I am proud to have been associated with this project in even a small way. It's important and it will reach well beyond the walls of a hospital in Boston."

Dr. Tom Delbanco, Chief, General Medicine, Beth Israel Deaconess: "I thought you did a fine job with the Frontline piece. It both increased understandings and got folks thinking hard - people from all walks of life - ranging from those working here to lay people who had never thought about the issues. I also thought you were fair to our hospital - which was terrified by what you might have done - and were clear in your exposition of a difficult set of issues. As always, there were parts one might do differently, but I congratulate you. I look forward to watching the rest of your series."

Dr. Mitch Rabkin, President Emeritus, Beth Israel Deaconess Medical Center: "I thought "Dr. Solomon's Dilemma" was a clear-eyed presentation of the conflict that confronts both doctors and hospitals: to do the right thing for patients today and yet remain financially viable to be able to do the right thing for patients tomorrow. With respect to rationing of care, it's easy enough to argue for more but I don't see many people offering to pay for more. We need a system of care that delivers the right care, prudent in spending the resources to deliver the right care, and fair in the payment for those resources. This will require involvement of those who provide care, those who pay for it, and the patients who benefit from that care. But even with an ideal system there will have to be some limits; otherwise we'll be right back at uncontrolled inflation followed by the same sort of onerous dilemmas that confront us today. "
[E-mailed to Frontline website]

Jon Humphrys, son of patient, Lillian Humphrys profiled in show: "It wasn't easy for us to participate in the show considering what we were going through at the time but you guys were nice and respectful and in the end we liked the program very much. It's important for people to know what these plans entail and you explained it very well. It hurt to see the pictures of Mom like that in the hospital, but that was the reality. It's what a lot of people go through. I've had a lot of people come up to me at the coffee shop or wherever and say, "Hey weren't you on TV last night?" I guess a lot of people around here saw it. I just hope it can help somebody. I wish I had known about some of the things you raised in your program."

Dr. Atul Gawande, surgeon, Brigham andWomen's Hospital, Boston; staff medical writer, The New Yorker: "Wow! What a wonderful program you put together. It certainly managed to avoid the usual boredom of reporting on health financing issues. Congratulations. It's well deserved.

"I couldn't help but watch the piece from a variety of different perspectives, and let me try to give them to you. As a writer, I found the show very well executed, with tremendous drama and build up. The story line was simple and easy to follow. More importantly, you have clearly hit on and emphasized the TRUE problem in health care today. It's not the insurers, who've given up on managed care. It's now the doctors, who both control the budgets and provide care. And you made it clear just how acute and terribly frightening those contradictory demands are. (By the way, the early coverage in the Sunday NYT was a tremendous coup.)

"As a doctor, your piece felt right on the money. These are exactly the very pressures everyone is under. And it does stink. It'll be fascinating to see how people walked away from the program. Did they come away thinking that (a) we've got get rid of these villainous administrators and "let" doctors practice medicine or (b) we've got an impossible dilemma on our hands and are going to have to make some tough choices in the future?"

Diane Bernstein, Chairman, Children's Health Care Coalition, DC: "You hit the jackpot again. I'm devastated and screaming and angry. But what a hell of a program! I know it's going to shake a lot of teeth. I hope to God something comes of it. It was brilliantly done. And I don't want to hear it, but we have to. You're going from strength to strength. Keep going. You're really shaking this country's teeth."

Frank Karel, Vice President, Robert Wood Johnson Foundation: "The buzz here is very positive…. Everyone here says it is a fine piece of work."

Stuart Schear, Senior program Officer, Robert Wood Johnson Foundation: "It was the best report on the inner-dynamics of physician groups that I have come across. I liked that you took a very specific situation and looked at it very carefully. I thought that the entree you were granted was remarkable, and I think that all of the doctors and administrators should be admired for being so open with you. I think that they, like you, provided an important public service.

A number of my colleagues thought that you were a bit too easy on the academic health centers, which have been prodigious wasters of money for some time. They also felt that you gave less attention than you might have to some questions. For example, should any health plan be required to pay for medical education? If so, why does it fall on the health plans that have

contracts with academic health centers? I agree with some of these remarks, but I also understand what it is like to produce a good hour of TV. I think that you boiled down the issues without being simplistic at all."

Dr. Michael Makeover, internist, author, and professor, New York University Medical School: "I enjoyed your documentary on the Boston hospitals. It was very well done. I saw your interview with Charlie Rose. I was eager to join the debate about managed care."

Margaret Lyons, Communications Officer, California HealthCare Foundation: "I thought your program "Dr. Solomon's Dilemma" was terrific. The access to the people and the process was highly unusual and the honest that you were able to draw out of the people was incredible. Overall, I thought the educational component of the program was outstanding. We have gotten many calls from health professionals and key members of the health committees in the California legislature, wanting to get copies."

Barak Goodman, Independent producer on health care for PBS: "I congratulate all of you on an absolutely wonderful show. Incredible! Very clear, very dramatic. We know how difficult the terrain is because we have worked it too. But somehow you managed to nail it. Congratulations - really terrific."

Responses from viewers who took part in Frontline chat:

Viewer, Minneapolis: "This is a very shocking report? I live in Minnesota and I would like to know if my state has the same situation."

Viewer, Las Cruces, NM: "Congratulations on an excellent and thoughtful show. Do you have any statistics on what has happened to incomes of physician specialists, e.g. rehabilitation and other experts for eldercare, in the Boston area in the last three years?

Casey Newton, Albany, GA: I work in a managed care field and was very interested in the programs that produced the reports that Dr. Solomon reviewed with Pod 11. I think that level of data would help any managed care field. Can I get more information about the software?

Viewer, Punta Gorda, Florida: "I found this show very informative and disturbing. These are issues I have trouble discussing with the doctor - don't want to upset him, right? I heard "10 questions to ask your doctor" somewhere in the show, but can't find it on the site. Where might I find this information? Many thanks."

Viewer, Newton, Ma: "You show was terrific but very disturbing. My health plan is Blue Cross, which is not an HMO. I am also a patient of Dr. Solomon. My question is, does the information presented in the Frontline program only apply to people who are in HMOs or are people like myself also affected?"

Norbert Guimond, Phoenix: "Were you able to ascertain how much the doctors in Pod 11 were paid for their practices when they joined CareGroup? CareGroup is probably in a precarious position because they over-paid physicians for their practices. And after making substantial gains from selling their practices, physicians are now complaining about having to pay the bill now."

David Vigder, MD, Chicago: "I am a physician struggling with capitated health care on a daily basis. In the report featuring Dr. Solomon, you failed to focus on a driving force behind the decline of our system. The patients have chosen to accept less expensive insurance plans that will not pay for the high quality care they expect. How can a patient complain about her doctor's concern about the cost of her care if she or her employer has chosen to pay for the least expensive health plan? Also, why was there no mention of the responsibility of the government and its voters for the continued reduction in Medicare reimbursement? Someone has to pay for the excellent care we are able to provide. Patients must realize that if they continue to demand lower premiums from their insurance companies, they will get lower quality care."

Daryl Gilmore, Charlotte, NC: "With the rising costs of healthcare, what can consumers do to get the kind of care needed? I am in an HMO and there are recent reports that the Nalle Clinic will have to start paying its doctors less and this could result in many of the physicians leaving. If this kind of thing is occurring now, what is going to happened 10, 20 years from now?"

Sample Telephone calls from viewers to HSP:

Herbert Wasserman retired hotel executive, NYCity cancer patient: "That was a really powerful program on Frontline. Of course, as a patient I was interested, but you made the stories and the issues compelling. It's amazing that you got all those cogent people on camera for interviews and how you were able to get such wide access to those hospitals and those doctors. That made it a very important show for everyone to see."

Gerald Neery, Attorney, Summit County, New Jersey, diabetes patient: "I just called in to tell you that I thought your program on the Boston medical care situation was excellent, just excellent. We need to see more programming like that on TV."

Lauren Cardillo, CNN producer: "Congratulations on the impressive reviews earned by and the positive reaction to your Frontline program about health care. You must be pleased with the final product. It's a particularly tough subject to make into good television."

Col. Joe Sandaal, retired Air Force officer: "Your program on health care was timely and very interesting. I was very impressed. Your production and direction were excellent. Our daughter and son-in-law are both doctors - graduates of the Uniformed Services University of Health Sciences at Bethesda, Md. It would be interesting to see how they, as military doctors, view civilian practice. As for me, I really enjoyed your production and hope to see more in the future."

Kate Medina, Senior Vice President, Random House: "I loved the show last night. I was fascinated. It opened my eyes to things I didn't even know were happening and are affecting all of us. It was a wonderful, wonderful program. Congratulations!"

Rocky Kistner, Independent producer on health care for PBS: "Congratulations on the Frontline piece. I learned a lot from it. A powerful piece of journalism."