The COVID-19 pandemic brought into sharp focus how misinformation can threaten health. However, medical misinformation did not begin with the COVID-19 pandemic and it will not end with it. Countering misinformation requires addressing long-standing challenges that operate within social, psychological, economic, technological, and political dynamics. COVID-19 misinformation is the latest expression of enduring myths and conspiracies that are (re)framed to fit current contexts. Battling misinformation has become daunting for physicians and can lead to burnout and harm physician-patient relationships.
In a national focus group of physicians representing various specialties, physicians voiced that they are less likely to address misinformation in clinical settings because of concerns about conflict, time constraints, and a lack of training on how to manage misinformation. Physicians are more likely to correct false information in online settings.1,2 Addressing misinformation with patients—in person or online—has been largely left out of medical education, leaving physicians to rely on their own strategies.
MisinfoRx: A Toolkit for Healthcare Providers is a resource created by a team of researchers and a clinician trained in media and medicine that offers an overview of the mechanics that foster medical misinformation and the factors that make individuals susceptible to it.3 The toolkit also provides strategies for addressing patient-held misinformation in clinical settings. MisinfoRx can be used in medical school and graduate medical education to empower health care professionals to tackle these difficult yet important conversations. Practicing physicians can use the toolkit to educate themselves about these issues. In addition, patient education campaigns focusing on health literacy can be a community-centered approach that informs patients about media manipulation and how to identify false news.
Online and offline interventions to fight misinformation require different approaches. Online, the focus should be on reducing the spread of misinformation. In offline contexts, such as an office visit, an appropriate setting should be provided to start a conversation about health beliefs to educate patients. This editorial summarizes strategies from the toolkit to aid family physicians in fighting misinformation.
Initiate bidirectional conversation by asking open-ended questions such as, “Tell me more” or “What concerns you most?” Allow for patient self-expression through active listening, keeping an open posture, and avoiding interruptions or the urge to correct. Identify what matters most to the patient by looking for:
Cultural characteristics: ideologically conservative or liberal, member of a disenfranchised group, member of an orthodox religious community
Individual morals, values, and goals: value-taking actions that are beneficial to a larger community, concerns about their child's long-term health, desire to play an active role in decisions about their family's health
In-group norms and approved behaviors: trust in the opinions of in-group leaders, wish to act in ways that align with their social network
Empathize with the patient's concerns. Recognize the initiative the patient took to search for health information. When attempting to respond to inaccurate information or conspiratorial beliefs, account for the values, motivations, biases, and influences that you identified when learning about what matters to your patient.
Offer patients new evidence to consider by asking permission to share what you know about the topic. If they give permission to do so, begin by acknowledging what parts of the information the patient offered are true. Then proceed to briefly explain what is false and why. Avoid simply telling the patient that they are wrong. Instead, spend more time focused on why the evidence you have is correct and what that means to the patient's health. Ask the patient how they feel after hearing the information you shared.
Explore your patient's medical sources (e.g., family, friends, news, websites) and seek to understand the patient's preferred method for obtaining information. This can give a sense of the patient's health literacy. Avoid shaming or expressing judgment. Offer reputable resources from the patient's preferred method of obtaining information that reiterate what information is true and why.
Identify common ground between your goals for the patient and the patient's goals for themselves. Express your intention to support them in working toward these outcomes. Offer your final recommendation with agency. Be prepared for the patient to disagree, and be willing to readdress the issue in the future.
Do not engage with false information online because this may increase visibility from website algorithms. It is best not to reshare or comment on misinformation, even in an attempt to correct it. For the same reason, beware of and ignore internet bots, trolls, and spam.
The most effective solution to limit the reach of inaccurate online information is to expose internet users to more accurate than inaccurate information. Contribute to improving this balance by viewing, liking, resharing, and commenting on verified content from reliable sources.
If you have an online presence as a family physician, build and cultivate your audience. Post accurate information often and consistently. Develop a publication routine and stick to it. This will help you become your audience's go-to source for reliable information.
Medical misinformation is one of the most threatening challenges to global health. Misinformation can hinder the cohesiveness of societies by increasing existing social inequities, stigmas, gender disparities, and generational rifts. To a fatigued physician, discussing misinformation may seem futile, but the power of the physician-patient relationship should not be underestimated. Physicians are considered the most trusted messengers of medical information.4 We can use this privilege to help keep patients safe by educating ourselves and future physicians about strategies to fight misinformation.
Editor's Note: Drs. Shajahan and Pasquetto are part of the team that created MisinfoRx: A Toolkit for Healthcare Providers.