How Can Doctors Retain Patients’ Trust?


Strategies for combating the ‘infodemic’ of COVID-19 misinformation

Recent polls show that public trust in U.S. health experts is declining. This comes at a critical time, since dozens of vaccine candidates are currently in clinical trials, with an effective vaccine expected to be widely available by mid-2021.

Many Americans are hoping for a COVID-19 vaccine that will control the virus that is ravaging the globe—however, “a vaccine is not a magic end-the-pandemic button,” said science reporter Umair Irfan on recent webinar hosted by the USC Annenberg Center for Health Journalism.

Trust plays a significant role as well. “Public opinion is everything. If the public doesn’t trust it, they’re not going to get it. That’s going to be the major player,” said science reporter Dan Vergano, who noted that only about 20 percent of Americans got the H1N1 vaccine in 2009.

What can doctors do to combat misinformation and shore up patients’ trust to ensure the best outcomes for all?

The ‘infodemic’ in the midst of the pandemic

According to a new poll from the nonpartisan Kaiser Family Foundation (KFF), “the public’s trust in the Centers for Disease Control and Prevention and the U.S.’s top doctors, like Anthony Fauci, is rapidly dropping, particularly among Republicans,” reported STAT News.

In a July 17 editorial in The Lancet, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, was quoted as saying, “We’re not just fighting a pandemic; we’re fighting an infodemic.” The editorial highlights the concerning and even dangerous effects of fake news, misinformation, and conspiracy theories during the COVID-19 pandemic, particularly because it undermines trust in health institutions and experts.

In our May 1 post, Rendia discussed this problem with Tara Kirk Sell, Ph.D., M.A., a senior scholar at the Johns Hopkins Center for Health Security whose research focuses on pandemic preparedness and public health communications and policy responses to public health emergencies.

“Misinformation and disinformation really have the potential to—and may be designed to—cause deterioration of trust. And when we don’t have trust in our communication we can’t get people to do the things they need to do. They don’t support public health or doctors or other health care workers in the work that they’re doing. And in losing trust, public health care will lose the battle against disease.”

“Standing up for your patients and what’s right for health care is not political.” —  Vineet Arora, M.D.

So how can doctors educate patients, maintain their trust, and not get caught up in divisive politics when even masks have become a partisan issue?

“There is a real concern among physicians about not wanting to alienate their patients by getting quote-unquote political,” Vineet Arora, M.D., a co-founder of the Illinois Medical Professionals Action Collaborative Team (IMPACT) told the Association of American Medical Colleges (AAMC). “Standing up for your patients and what’s right for health care is not political.”

Build on trusted relationships

The KFF poll, conducted Aug. 28 to Sept. 3, found that nearly half of adults hold at least one misconception about COVID-19 prevention and treatment. This includes one in five people who believe wearing a face mask is harmful to your health—despite the growing body of evidence showing masks help fight the spread of the virus. According to the American Medical Association (AMA), “The epidemiological experts at the University of Washington’s Institute for Health Metrics and Evaluation are estimating that if 95 percent of Americans wore masks, the expected U.S. death toll between now and Nov. 1 would be cut by nearly 34,000 cases.”

But facts aren’t enough to change some people’s minds, as many doctors have discovered the hard way. “Doctors say patients regularly resist their counsel, more inclined to believe what they read on Facebook than what a medical professional tells them,” reported the New York Times in an Aug. 17 article. “The falsehoods, they say, have undermined efforts to get people to wear masks and fueled a belief that the seriousness of the disease is overblown. Some doctors say they face abuse when they participate in online discussions to correct the record.”

Those finding success battling misinformation cite several key strategies, according to the AAMC:

  • Use facts but don’t lecture.
  • Build on relationships.
  • Focus on shared goals.
  • Don’t challenge core beliefs.
  • Meet people where they are.

Instead of—or in addition to—trying to educate strangers on social media, start with your friends, family, and current patients who already have a relationship with you. A 2019 Gallup poll ranked nurses and doctors first and third, respectively, for perceived honesty.

A 2019 Gallup poll adds to the body of research that says doctors and nurses rank highly for honesty and trust. 

“Doctors, not just the ones on the front lines, have a really important role in communicating true information to their patients and other members of the public because time after time, the research tells us the person patients trust the most is their doctor,” said Sell.

Even the KFF poll reporting dwindling public trust found that respondents still trust Dr. Fauci the most, more than the CDC, the White House coronavirus coordinator Dr. Deborah Birx, President Trump, or former Vice President Joe Biden.

3 common patient scenarios and how to handle them

So what does combating misinformation look like in real life? Here are a few common scenarios doctors encounter.

People reluctant to wear a mask. “The most common pushback that we’re feeling right now is that there is a politicizing of the use of a mask. This has nothing to do with a political party,” Arizona endocrinologist Ricardo Correa, M.D. told the AMA. “People need to understand that this is a public health problem and it has nothing to do with the election of 2020. This is happening across the entire world.”

Phil Cochetti, a research coordinator at Perelman School of Medicine at the University of Pennsylvania, told the AAMC he has made progress with some people by finding common objectives (such as safely reopening schools) and suggesting that the potential benefits of some precautions are worth a minor inconvenience. “I’ll say, ‘Other countries have been successful with masks. Why not try wearing one?’”

People overwhelmed/confused by all the information. In fact, a large part of the COVID-19 infodemic isn’t misinterpreted findings and conspiracy theories, but simply information overload, according to Lindsey Leininger, Ph.D., a data analytics professor at Dartmouth College’s Geisel School of Medicine. She and several other health and science researchers created a Facebook project, Dear Pandemic, that provides science-based answers to common questions, such as, are temperature checks an adequate screening tool for COVID-19? What is herd immunity and how does it work?

Dear Pandemic aims not only to answer specific questions but also to teach readers how to assess scientific pronouncements. “We’re trying to coach people to think critically,” Leininger told the AAMC. “We’re trying to build a community of people who can go educate others.”

If you have patients who get most of their info from Facebook, you might refer them to Dear Pandemic, or provide frequently requested info on your own social media sites, such as safety measures your practice is taking to prevent the spread of the virus.

Eve Bloomgarden, M.D. tells patients, “Politics aside, Facebook and news outlets aside … I don’t care about what anybody else says. I care about you.”

Conspiracy theorists. While disengaging from closed-minded strangers may be the best course of action online, doctors are in a difficult spot because they can’t just disengage from patients, who might contract the virus and spread it. “I have a few patients who are sure this is a conspiracy,” Illinois endocrinologist Eve Bloomgarden, M.D., told the AAMC. “I stand my ground.” She tells these patients: “My role is to see that you don’t get sick. Politics aside, Facebook and news outlets aside … I don’t care about what anybody else says. I care about you.”

Trust is a major issue in health care that can affect patient outcomes and practices’ bottom lines. Lack of trust is the #2 reason patients will leave a practice and find another doctor. Your patient education is one area where you can either erode or build trust. 

Narrated animations are perceived by patients as 1.2 times as trustworthy as text-only materials. Check out our infographic on the impact of different types of patient education.

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