Joseph Hill, MD, PhD, chief of cardiology at University of Texas Southwestern Medical Center, has experienced firsthand a problem most doctors will eventually face: the consequences of bad medical information.
One of his patients, a middle-aged woman with a history of coronary artery disease, has declined to take a statin, which would significantly lower her risk for heart attack and stroke, largely because of what she’s read online.
“I meet with her every year, and each year she has another reason for not wanting to take a statin,” Hill says. “She’s so focused on what she’s reading on the internet about these unlikely and largely reversible side effects that she’s not willing to move ahead.”
In the information age, bad medical advice is rampant. From social media posts to blogs to self-proclaimed but unlicensed “health gurus,” doctors must work to combat false claims on a daily basis.
“As physicians, we all encounter patients armed with preconceived ideas, and a lot of times they are misinformed. There’s a great deal of misinformation on the internet and social media.”
Joseph Hill, MD, PhD
University of Texas Southwestern Medical Center
The spread of bad information has had dire consequences. A fear of vaccinations has led to a nationwide measles outbreak: From January 1 to April 29, 2019, 704 individual cases of measles have been confirmed in 22 states, according to the Centers for Disease Control and Prevention (CDC), and the number of cases continues to rise. This is the greatest number of cases reported in the United States since measles was eliminated in 2000.
Doctors are working to combat this phenomenon on multiple platforms. Hill was one of more than two dozen editors of cardiology-related scientific journals around the world to publish an editorial in January 2019 in Circulation “to sound the alarm that human lives are at stake” because of medical misinformation.
“As physicians, we all encounter patients armed with preconceived ideas, and a lot of times they are misinformed. There’s a great deal of misinformation on the internet and social media,” Hill says. “The intent was to shine a light on this issue that really does harm human beings.”
Medical schools and teaching hospitals also are stepping up efforts to combat misinformation. Though it can’t be seen in the formal curricula, institutions are using patient simulations, interpersonal training, and lessons about disseminating scientific information to laypeople to help equip students and residents with the skills they need.
The dangers of misinformation
Medical misinformation is not a new problem. On December 28, 1917, an article titled “A Neglected History” appeared in the pages of the New York Evening Mail, written by H.L. Mencken. The piece blasts the invention of the bathtub, saying physicians opposed it and deeming it dangerous to health, inviting “phthisic, rheumatic fevers, inflammation of the lungs, and the whole category of zygomatic diseases.”
With the advent of new technologies and platforms, bad information has only become more easily accessible and widespread. For every effective medication or treatment, there are false claims online about supposed dangers associated with them. People sometimes turn to herbal remedies and essential oils in lieu of medical treatment, despite the lack of science to support their effectiveness.
And sometimes, misinformation can have life-threatening consequences. Such is the case with parents choosing not to vaccinate their children, despite considerable evidence that the vaccines are safe. According to the CDC, the number of children who are not vaccinated against preventable diseases has quadrupled since 2001.
“Students have actors and actresses playing the roles of patients, and they’re given complex cases. Sometimes that involves having difficult conversations with people who have belief systems that are very different from their own.”
Lisa Jane Jacobson, MD
Jacobs School of Medicine and Biomedical Sciences
“The big [mistaken] concerns are that children get too many vaccines too soon, and that’s somehow weakening or overwhelming their immune systems, causing them to have a variety of chronic illnesses like autism, diabetes, or multiple sclerosis,” says Paul Offit, MD, professor of pediatrics at Children’s Hospital of Philadelphia and a world-renowned expert on childhood vaccinations. “We’re on our way to one of the biggest measles epidemics in the last 20 years because parents are making that choice.”
Offit says 18 studies affirmed the safety of the measles, mumps, and rubella (MMR) vaccine, including a decade-long study of more than 650,000 children in Denmark. The study results released this year in Annals of Internal Medicine concluded there was no increased risk of autism in children who had the MMR vaccine and no evidence that it triggered autism in susceptible children.
Offit says there are two types of people hesitating to vaccinate. One group “smells the smoke and wants to know if there’s any fire” — meaning they have heard concerns and are looking for more information. It is possible, he says, to reassure that group.
However, there is also a population who believes there’s a conspiracy to sell product by drug companies that are intentionally hurting children. “That group is not going to be convinced,” Offit says.
But, he says, giving patients up-to-date scientific information is generally a helpful solution. “With the right information I find I can generally convince people to vaccinate,” Offit says.
Armed with truth
Educating patients is always the first best option, experts say. As an example, take antibiotics. Many patients will ask for them to treat viral illnesses that may not be helped by medications, says Michael Wilkes, MD, professor of medicine in global health at University of California, Davis (UC Davis).
While some doctors may be tempted to prescribe the unneeded antibiotic rather than explain the difference between viral and bacterial infections, Wilkes stresses the need to avoid what he calls the “Yogi Bear Phenomenon.”
“If you feed the bears, they’re going to lose the ability to think independently,” Wilkes says. “Our job is to help patients arrive at the best solution.”
Staying abreast of the most relevant, evidence-based information about patients’ conditions and treatments can help, says Allen F. Shaughnessy, PharmD, MMedEd, professor in the department of family medicine at Tufts University School of Medicine. Students and residents are encouraged to constantly evaluate the information they have so they can keep their patients apprised of the latest developments.
“The process of managing one’s information inventory is taught throughout residency,” Shaughnessy says. “They have to be critical of the information they have.”
Having difficult conversations
Medical schools also spend considerable time teaching students and residents how to have difficult conversations with patients about what they can and cannot believe on social media. At UC Davis, simulated patient experiences are used for just those purposes.
“We spend an awful lot of time in the curriculum with standardized patients,” says Willkes. “We have those difficult conversations with patients who are skeptical. They don’t trust the medical profession, and those conversations can be very difficult or frustrating. But it’s better to have them with a standardized patient than having them for the first time with a real patient.”
The same standardized patient approach is used at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.
“Students have actors and actresses playing the roles of patients, and they’re given complex cases,” says Lisa Jane Jacobson, MD, associate dean for medical curriculum at the school. “Sometimes that involves having difficult conversations with people who have belief systems that are very different from their own.”
Donna Elliott, MD, vice dean for medical education at Keck School of Medicine of the University of Southern California, says a scientific communication faculty member meets with first-year students for a workshop focusing on how to communicate with patients. The faculty member then returns in the third year to discuss ways to convey complicated concepts to patients, and how to break down complex scientific information.
“The sheer volume of opinions people are exposed to — whether it’s for ad revenue or on social media — is overwhelming. As their doctor, you need to be mindful there’s an information disconnect, and provide reassurance.”
University of California, Davis
The school received a $30,000 grant from the American Medical Association specifically to develop competencies in digital health literacy. This includes teaching students how to take information found online by their patients and interpreting it for them, Elliott says.
“We have a number of initiatives on campus in digital health. We’re thinking of all the things that are coming at us as physicians, residents, and patients,” Elliott says. “It’s a new world.”
Dale Till, a third-year student at UC Davis, says he has learned to approach patients with an understanding, trust-building demeanor rather than lecturing them. The doctor’s role is to minimize harm, he adds, and part of that means being up front with patients who simply have the wrong information.
“It’s about being honest with them,” Till says. “The sheer volume of opinions people are exposed to — whether it’s for ad revenue or on social media — is overwhelming. As their doctor, you need to be mindful there’s an information disconnect, and provide reassurance.”