Misinformation has grown increasingly prevalent in healthcare. As we’ve branched away from the Information Age and into the Digital Age, we’ve seen a boom in information mixed with lived experience and a heightened element of hyperbole.
Scroll-stopping entertainment clips on social media platforms are armed with clickbait and shock factors, and in 15 seconds or less, we are made to believe we were succinctly educated or played to become emotionally outraged, driving us to the comments, which further boosts the post’s algorithmic spread.
There’s no doubt misinformation has infiltrated our practices, but how we identify it and combat it requires just as much critical thought as your next diagnosis and treatment plan.
Step 1: Listen with empathy.
If I asked you to visualize your greatest clinical tool, what would come to mind? Is it your lenses, intense pulsed light (IPL) machine, or meibomian gland expressors? I’m willing to bet the answer isn’t something physical, and your Google reviews would agree.
The largest asset a physician can have is empathy, which in turn can become an invaluable asset in correcting misinformation. Empathic listening involves the awareness of facts and emotions in addition to specific words others are using. Its active form includes mirroring and mimicking.
The benefit of listening with empathy is that it creates a sense of support without direct validation. Therefore, when an inaccurate claim is presented, preemptively starting with empathic listening can set up a successful counter.
Step 2: Identify the driving factors of the misinformation
In January 2022, Nature Reviews Psychology published an extensive article on the driving factors behind misinformation. The authors explored a mix of cognitive factors, such as lack of analytical thinking, neglectfulness towards sources and counter-evidence, and familiarity as mental missteps.
Nature also identified socio-affective drivers like personal views and partisanship, social “in-group” bias (i.e., aligning with those that have views or social status closest to our own), and emotional state.
Cognitive factors may be harder to identify in an otherwise short exam encounter, but through empathic listening, I’ve found emotive information to be one of the most powerful driving factors behind misinformation. Whether that be anxiety, fear, or denial, it’s important to identify what is emotionally driving the patient towards misinformation.
Determining the source and driving emotion behind misinformation
If you can’t directly identify their driving emotion, one recommendation is asking them to outright identify it with you. “Mrs. Smith, do you feel like there are some emotional barriers to receiving treatment? If we identify them together, perhaps we can work through that.”
Social “in-group” bias can be exemplified in statements like, “Well, I remember my grandma having cataract surgery, and she was in the hospital for days.” The patient identifies someone like themselves (a family member, now of the same age) having an anxiety-provoking experience.
Fear can manifest through statements like, “I can’t stand the idea of a shot going in my eye, especially if there is a risk for blindness.” Denial can sound like, “I was told by other doctors that surgery for glaucoma is the last result.” There’s power in identifying emotions behind misinformation as they more easily allow you to disarm the false statements.
Step 3: Combating misinformation in the optometry clinic.
There are several ways to combat misinformation. One intervention is fact-based correction. Just last week, I had a patient state that she didn’t feel like their cataract surgery was done right. The patient saw 20/20, so I inquired further about the specifics.
The patient recounted that when they were coming out of surgery, they heard a nurse comment that the “surgeon was fast.” I understood that to this patient, “fast surgery” emotionally equated to “poor surgery.”
I chose a fact-based approach to discuss the rates of surgical complications in high-volume centers:
“Patient Smith, I understand a comment of that nature can make you feel anxious about the quality of care you received. Luckily, we have studies that evaluate surgeons in high-volume clinics, and evidence shows us they actually have some of the lowest risk of post-surgical complications, namely post-operative intraocular infections. Would you like me to share some of these studies with you?”
Another approach is addressing logical fallacies. In the case of injections causing blindness, we can remind patients there is a risk of cherry-picking only one piece of data (the risk of treatment) when, in reality, there is risk in not treating the condition as well.
“Mrs. Lee, it’s natural to consider rates of blindness with intraocular injections. However, we’d be negligent if we didn’t equally evaluate the risk should you not pursue treatment. Let’s be sure to discuss those numbers as well.”
Step 4: Preventing further misinformation.
Educational resources are the best way to prevent further misinformation from occurring. For patients who have a drive to learn more about their care, share the most credible sources like the National Institutes of Health (NIH), American Academy of Ophthalmology (AAO), and American Optometric Association (AOA). While you may not be ready to dance your way to education, creating accurate information on social platforms can be extremely effective as well.
Finally, if there’s an option to meet a patient’s desire for care, see if you can lean in. While not all diseases are amenable to different treatment plans, with dry eye disease, I’ve seen a reasonable uptick in patients not wanting to rely on pharmaceuticals for management.
For these patients, I try to offer more natural options like serum tears vs. topical pharmaceuticals, fish oil vs. doxycycline, and advanced in-office procedures vs. intermittent use of topical steroids if it's something they value.
Conclusion
The COVID-19 pandemic wasn’t the start of misinformation, but it certainly showed us the capabilities of the breadth of internet power and social programming.
As physicians, we share an important role in maintaining the overall safety of public health, starting within the four walls of our exam rooms.
