Partnering With Patients to Combat Medical Misinformation
Myths and misconceptions about health care are everywhere — two nurse practitioner experts explain what clinicians can do about it.
Browsing for health care advice can result in a flurry of eager, and often unscientific answers — that vitamin C therapy can treat cancer, for instance, or that mRNA COVID-19 vaccines “alter DNA.” But swatting at every medical myth that patients bring up to their nurse practitioner (NP) may miss the point. In fact, it sidesteps some important factors NPs need to consider: where patients get their medical misinformation; why they trust those sources; and the fact that every one of us is susceptible to bias and misinformation.
In the first of three episodes of NP Pulse: The Voice of the Nurse Practitioner® dedicated to medical myths, Ruth Carrico, PhD, DNP, APRN, CIC, FSHEA, FNAP, and Paula Tucker, PhD, DNP, FNP-BC, ENP-C, FAANP, have a frank discussion about the role misinformation and bias play for both the patient and provider. After establishing why all of us are prone to bias — and the surprising reasons why — these NP experts walk us through the importance of critical thinking and how NPs can leverage the trust patients have in them to empower those same patients to make informed decisions.
Modern Misinformation
Every NP has encountered medical misinformation either in their offices, online or in casual conversation. Carrico touches on the origin of some misinformed chatter, explaining that “…it may be that the information is incorrect simply because someone has misinterpreted it — they don't understand, or they have made some assumptions that are not true and then they've begun to build their own story. But we know also, unfortunately, that some people enjoy mischief, and they will post information to be purposefully misleading.” If misinformation is shared widely online, it even has the potential of being utilized by artificial intelligence (AI) programs scraping the internet for data.
As Ruth Kleinpell, PhD, ACNP-BC, FAANP, FAAN, notes in the Journal of the American Association of Nurse Practitioners (JAANP), the popular AI chatbot ChatGPT has benefits like “improved scientific writing, enhancing research, efficient analysis of data sets and literature and improved personalized learning” but its downsides include “copyright, transparency, and legal issues; the risk of bias, plagiarism, lack of originality, inaccurate content, incorrect citations, and cybersecurity issues.” Inaccurate content spread through AI deepens a problem already manifested through algorithmic feeds on social media that reflect many of our own biases back at us.
But rather than trying to fight every instance of medical misinformation an NP hears, Carrico suggests an alternative where NPs take a different route. “I think that we've all learned that trying to explain misinformation takes us down a rabbit hole that we sometimes cannot climb out of.” She reminds the listener that “at the end of the day, we are not a parent to our patient. We are a partner to our patient. And that means we walk this journey together.” Part of that journey includes both meeting a patient where they are, and understanding the role bias plays in all of our lives.
Bias and Social Determinants of Health
In addition to being a frustrating task, simply trying to argue against every piece of misinformation misses the broader context of how and why patients turn to the sources they do for medical advice. Tucker shares that “As NPs, we often assume that if we just give our patients the right information, they'll make the right choices. But we know it's not that simple. Misinformation isn't just about facts — it's about trust, access, education and social context.”
It’s important to see the spread of medical misinformation as closely related to social determinants of health. “Misinformation disproportionately affects marginalized groups, not because of inherent differences in judgment, but due to structural inequities and access to accurate, credible health information,” says Tucker. “You see, not everyone has the same access to reliable health information. In fact, when we talk about misinformation, it's essential to recognize that its effects are not equally distributed across populations. Marginalized communities — those already facing systemic barriers to health — are disproportionately impacted by misinformation.”
Tucker gives a real-life example of a patient of hers in the emergency department “who presented with concerns for lower extremity edema.” The patient, who did not have health insurance, had purchased diuretics from an online retailer in the hope that it would be an affordable solution to her medical issues. “Economic instability certainly creates a barrier to accessing trustworthy health services, increasing the reliance on misinformation-driven alternatives,” Tucker explains.
Not having health care insurance or living in a health care desert means patients may see less of a primary care provider who can provide high-quality, evidence-based health care. On top of that, historically marginalized communities have valid reasons to distrust the health care system itself. “When people don't trust the system, they're way more likely to turn to alternative sources, even when those sources aren't scientifically sound,” says Tucker. “So, what do we do about it? Well, if we want to stop misinformation, we can't just say, ‘trust us,’ and expect people to blindly follow. We have to earn that trust back. And that means meeting people where they are — addressing their concerns without dismissing them and being transparent about what we do and don’t know.”
Earning trust also means looking within, and at our own biases. “And before you say, ‘nope, not me’ — yes, you do,” Tucker says regarding personal bias. “We all do. It’s how our brains work. Bias plays a fundamental role in the spread of medical information and in shaping how patients and clinicians interpret health information.”
Biases, though, “aren’t inherently bad,” councils Tucker. “They help us make decisions. But in health care, they can lead to errors in judgement, poor patient interactions and reinforcement of misinformation.” Instead of seeking to destroy bias entirely or trying to fight it, Tucker suggests we accept that biases are inherent in decision-making. “The key takeaway is that both clinicians and patients must be willing to challenge their assumptions, seek high-quality evidence and engage in conversations with an open mind.”
Recognizing bias is an important factor in making connections with a patient, and the other is realizing that building trust is more important than winning an argument. “Trust is the currency to the care that we provide, and without it, our knowledge means nothing to our patients,” concludes Tucker. “How are we going to build that trust? Trust is built through dialogue. It’s not dismissal. Patients need to feel heard before they are willing to learn.”
Learn More About Medical Misinformation and Earn Continuing Education Credit
Listen to “Wash Your Hands!: Discerning Facts from the Preposterous vs. Plausible;” complete the posttest and evaluation; and earn one contact hour of continuing education credit. Subscribe to NP Pulse for more episodes on medical misinformation: part 2 and 3 of the series are tentatively scheduled for release on April 23 and May 21, respectively. Finally, download the free resource “A Clinician’s Guide to Medical Misinformation: Recognizing Real Vs. Fake” for more advice on how to recognize and address misinformation.