By Michael Gisondi (@MikeGisondi)
Let’s start with an unlikely case.
You are a family physician leading an inpatient service that cares for patients with COVID-19. While preparing for rounds one morning, you overhear your chief resident counseling a patient about the use of a controversial medication to treat coronavirus. The drug in question received significant media attention, however it was later shown to be ineffective in clinical trials. The chief resident offers his medical opinion that the medication is still an effective treatment despite the current literature, and he describes ways to procure the medication online. He then writes a prescription for it. What do you do? Would your response be different if this was a faculty member colleague rather than a chief resident?
Yes, this is an unlikely case at most hospitals. However rare though, some physicians are the primary source of health misinformation, especially online. Misinformation refers to misleading or blatantly false information that is spread without harmful intent – much like the above case. In contrast, disinformation is erroneous information that is disseminated intentionally to harm an individual or society – in essence, a lie. Both health misinformation and disinformation cause confusion, promote conspiracies, and lead to negative health outcomes. Each has been increasing on social media at a rapid rate over the last decade, most especially since the start of the COVID-19 pandemic.
What does this have to do with health professions education?
In 2021, Dr. Vivek Murthy, the U.S. Surgeon General, labeled health misinformation a public health crisis and the greatest threat to COVID-19 vaccination efforts in the United States. His remarks acknowledge that we are in the midst of an infodemic. The World Health Organization defines an infodemic as “too much information or false and misleading information” that “causes confusion, risk taking behaviors” and “..a mistrust of health officials.” As health professions educators, I see 5 obligations that we have to our trainees and the public welfare:
- Identify health misinformation and label it as false. Bautista et al offer a two-step conceptual model for correcting health misinformation online, however similar principles can be used for addressing misinformation in the clinical learning environment. Phase 1 includes the verification of information to be correct or incorrect using authentication processes that fact-check the author, source, cues, and content of misinformation. Phase 2 includes correction preparation and correction dissemination. It is important that corrections not be shaming, and they come from a place of respect, empathy, inquiry, and understanding.
- Teach trainees to critically analyze online information. The traditional journal club is meant to provide trainees with the skills necessary to critically analyze the medical literature. Shouldn’t we do the same training for the analysis of medical blogs, podcasts, and online news sources? At first consideration, one might think that a trained health professional would know the difference between factual health information and health misinformation, or they would at least understand how to check the literature to tell these apart. But we live in uncertain – and frankly scary – times in which it is easy to fall prey to misinformation, especially if it is spread through traditional media sources. Consider the number of healthcare providers who still choose not to receive the COVID-19 vaccine because of misinformation about it. In an infodemic, our analytical skills are needed, and we must pass them on to our trainees.
- Recognize the differences between teaching and correcting misinformation. Teaching clinical facts in the workplace and correcting health misinformation can be fundamentally different. There is little emotion, politics, or culture to the correct dose of magnesium sulfate, and it is therefore quite easy to teach a trainee how to prescribe it. Health misinformation, however, may be more difficult to address based on the source of the erroneous content, who else in a community believes it, and the cultural stigma that comes from admitting such a mistake. It is not so simple to say, “that medication doesn’t treat COVID-19” and then walk away. More effort is required to understand where the misinformation was sourced and the depth of belief the individual has in it. Respect for the trainee is critical and the discourse should be free from emotion. See this helpful article by Sheng, Gottlieb, and Welsh.
- Acknowledge the position of our accreditation organizations. Given the risk of misinformation to public health, many accreditation bodies have new position statements that address physician involvement in the spread of health misinformation. In the fictional case above, how might you respond if your colleague were the source of the misinformation? Here are several position statements to consider:
- Federation of State Medical Boards (USA): “Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license.”
- American Board of Emergency Medicine: “Should ABEM determine that a physician is promulgating inaccurate information that is contrary to the interests of patients and that adversely impacts public safety, ABEM may withdraw or deny certification for that physician.”
- American Boards of Family Medicine, Internal Medicine, and Pediatrics (joint statement): “We also want all physicians certified by our boards to know that such unethical or unprofessional conduct may prompt their respective board to take action that could put their certification at risk.”
- College of Physicians and Surgeons of Ontario (Canada): “Physicians must not make comments or provide advice that encourages the public to act contrary to public health orders and recommendations. Physicians who put the public at risk may face an investigation by the CPSO and disciplinary action, when warranted.”
- Australian Health Practitioner Regulation Agency: “We will consider taking action against anyone found to be making false or misleading claims about COVID-19 in advertising. If the advertiser is a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative.”
- Determine a research agenda. Does the issue of health misinformation warrant investigation by health professions educators? Yes. This challenge is relatively new, there is little guidance for health professionals and health professions educators in the literature, and health misinformation is on the rise. JMIR Infodemiology is a peer-reviewed journal dedicated to this topic.
We as health professions educators are not immune to the effects of health misinformation on our trainees, patients, and society. We have an obligation to each of these constituencies to address this issue and mitigate the spread of COVID-19 misinformation.
About the Author: Michael A. Gisondi, MD is an emergency physician, medical educator, and education researcher who lives in Palo Alto, California. Michael currently holds a position as Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford University. Twitter: @MikeGisondi
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