Medical Misinformation Prevention - What Medical Professionals Can Do to Counteract Medical MisinformationMedical Misinformation: The Other Pandemic Blog Series, Part 3 of 3
In parts one and two of this blog series on Medical Misinformation, we described the harms associated with medical misinformation and common sources of medical misinformation, respectively. In this post, part three, we will examine some medical misinformation prevention strategies and how medical professionals can counteract medical misinformation.
Medical Misinformation Prevention - Respect, Trust and Communication
Sometimes it seems like our patients are listening to everyone but us — trained medical professionals.
We know that alternative sources of information have a tendency to tell patients exactly what they want to hear and to tell them such strident and confident tones that patients find easy to believe.
Medical professionals have to speak in somewhat guarded tones that convey the current states of the evidence, and sometimes this can seem like we are equivocating. Add to this a growing mistrust of the medical profession and you can see that we have a great challenge before us.
I would like to suggest recommendations on what we as healthcare providers can do to counteract misinformation.
You may be hoping to learn some rare Jedi mind trick that allows me to counteract misinformation with the wave of my hand:
(Me) “The influenza vaccine is safe and effective.”
(The Patient) “I think I WILL take the flu shot this year.”
You will find nothing like that here. Instead, at the heart of the problem is the need to develop a therapeutic relationship with our patients that is based on respect, trust, and communication.
Medical Misinformation Prevention - Steps to Take to Counteract Medical Misinformation
1) Eradicate any trace of contempt or condescension from your very being.
A friend of mine is a software engineer and whenever we have lunch I will occasionally make the mistake of asking him a computer-related question. The smirk will spread out over his face and he’ll begin speaking in a slow patronizing tone, sounding a bit like an overly earnest parent. Before he is finished, I have to fight off the urge to smash his Ramen bowl over his head. As it turns out, I am not the only one so averse to condescension.
In his book Blink, Malcolm Gladwell described how marriage counselors could tell within a few moments of watching a video of how a married couple interacts if the marriage was doomed to failure. The telltale sign? Condescension and contempt. Sighing and head shaking, eyes rolling, scoffs and laughs of disgust — if they picked up on telltale signs of contempt this was highly correlated with the marriage ending in divorce.
This same dynamic is present in therapeutic relationships. If the patient tells you about their concerns of vaccination or their enthusiasm about an alternative therapy, it’s important to explore these concerns with respect and equanimity.
I remember speaking with the patient who had recently changed cardiologists. The new cardiologist was recently out of fellowship and I’m sure would be fine but the old cardiologist had been in practice for 15 years and he was extremely well-regarded in the field. I asked the patient why he switched and he described how the old cardiologist “did not support” a particular diet program that the patient was pursuing. “In fact,” the patient said, “he laughed when I told him about the diet.” How did the new cardiologist respond to the patient’s diet? “He said he was impressed that I was on any kind of diet and that it’ll be interesting to see if it works for me.”
If patients detect any condescension or contempt they will turn you off like a light switch.
2) Allow our patients to develop an appropriate and healthy trust of our care.
When was the last time you left an auto mechanic feeling like a victim of highway robbery? For me, it was the last time I went to the auto mechanic.
I do not understand cars and the enormous expense that comes with seemingly mundane repairs, e.g. $600 to get my air conditioner up and running. Nevertheless, I fork over the money because I trust the guy. Over time he has shown me that he is not only good at what he does, but after comparison-shopping and second opinions his prices are comparable to industry standards. If I didn’t trust my mechanic there is no way I could pay that kind of money for repair processes that I do not understand.
Trust is at the heart of all service related interactions. Whether it be an auto mechanic, attorney, plumber, or orthodontist we must trust those that serve us for a sound interaction to occur.
Francis Fukuyama describes in Trust: The Social Virtues and the Creation of Prosperity how trust is essential to social transactions: “the expectation of regular, honest and cooperative behavior based on commonly shared norms... arises from the prevalence of trust in society.”
No trust, no honest and cooperative behavior. To be sure, trust must be warranted by trustworthy behavior on our part, but we should seek out opportunities to dispel sources of doubt.
Does the patient think your prescribing behavior is financially motivated? Talk with them and assure them that you have no financial interest in therapies (and don’t have financial interest in therapies).
3) Give them sound evidence-based information in a way that makes sense to them.
Several writers addressing the problem information have suggested that we teach our patients research methodologies as part of patient education. This may be unrealistic for the general population. There are practicing clinicians that don’t know a hazard ratio from and an odds ratio; why would we expect our patients to know or to understand the finer points of medical research?
Our patients come from all kinds of backgrounds, education, and lifeways, and I think it’s naïve to presume that we can inculcate an evidence-based mindset in the general population.
Rather, we can tailor patient education to suit interests and needs of patients — meeting them where they are.
For the patient inclined to research, recommending CDC website materials and even journal articles may be a useful way to convey evidence. Other patients may be less interested in the details of medical literature and have a “whatever you say doc” type of mentality. For these patients, we will have to formulate the evidence in ways that speak to them but also maintains the integrity of the information.
Finally, a word of warning... don't skip out.
In the rush of a busy clinic or ER shift, it’s easy to slip into the habit of lurching out of the room and letting the nurse take care of patient education. Nurses are amazing at patient education but a concerted team effort is always more effective. If you are the treatment leader of the patient, then you are on the line for patient education at all times. To some patients, you may be the only voice that has any weight.
I am convinced that there has never been a time when patient education is more important than today. Rampant misinformation, tribal divisions, and partisan vitriol are all having a corrosive effect on civil discourse. Sitting down and speaking face-to-face with our patients in an environment of mutual positive regard may go a long way in re-establishing a therapeutic relationship.
Until we establish such a relationship, we will be heard as just another claimant for our patients’ trust competing against a world full of charlatans, fools and trolls.
Hopefully, with these medical misinformation prevention strategies in mind, we can all march forward together toward a healthier future with more speed.
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