Make the system work for the patient
Individual conversations matter, but so does the system surrounding those conversations. When clinic workflows, appointment lengths, access to follow-up and educational materials are aligned with shared decision-making, patients are far more likely to engage constructively. Practical steps include:
• Building in time for questions or scheduling a short follow-up specifically to revisit contested topics.
• Providing concise, culturally appropriate educational materials that the patient can take home or access online.
• Ensuring that support staff( nurses, medical assistants, patient educators) are trained to reinforce consistent messages and to document concerns for follow-up.
• Using decision aids when appropriate, simple tools that lay out benefits and harms in plain language and help patients weigh options relative to their values.
Accepting“ no” as“ not yet”
A patient’ s initial“ no” is not necessarily a final verdict. Treating refusal as provisional keeps the door open. That may mean returning to the topic later, offering a smaller step or proposing a trial period. Sometimes refusal or resistance is pragmatic: a patient may decline a treatment because they can’ t afford it, can’ t take time off work, lack transportation or fear side effects without a plan for management. Identifying and addressing these barriers often resolves the apparent“ contradiction.”
Approaches that respect autonomy while maintaining connection aid in the possibility of future agreement.
Countering health misinformation
Our lives are saturated with contradictory health information. Patients arrive with symptoms that are associated with self-diagnoses, curated online data and deep-seated fears amplified by misinformation. When a public figure makes a baseless health claim, it creates a genuine clinical risk. Our job, however, is not to win an argument, but to re-establish ourselves as the patient’ s most trusted, non-judgmental source of truth. This requires a shift from confrontation to empathetic correction.
When a patient brings up a piece of misinformation, our instinct may be to correct the fact immediately. This can trigger cognitive dissonance, leading the patient to reject our entire premise to protect their existing belief. Instead, we must start by validating their underlying concern.
Acknowledge the fear, not the falsehood.
Let’ s take the Vaccine Schedule as an example.
* Patient Concern:“ I saw online that the vaccine schedule has too many shots, too close together. I think it’ s overwhelming my baby’ s immune system.”
* Ineffective Response:“ That’ s wrong. Studies show the schedule is perfectly safe.”( This shuts down the conversation.)
* Effective Response:“ I appreciate you bringing that up. Your concern is a good one. You’ re focused on protecting your baby from being overwhelmed, and I share that goal completely. Would it be alright if I briefly explained why the schedule is timed the way it is?”( By starting with the shared value, i. e., protecting the child, you have established trust and gained permission to offer information. The patient is now listening to a partner, not a lecturer.)
Employ the“ truth sandwich” for correction
When I need to correct a specific false statement, I tend to frame the accurate information around the myth, using the“ Truth Sandwich.” This minimizes the chance of the patient remembering and reinforcing the false claim. The setup is Truth / Warning / Truth. For example, having a balanced discussion about the potential adverse effects of medicines as weighed against the need for and benefits of the medicine can be difficult, especially when myths unsupported by truths are everywhere.
Start with the truth( the bread): State the accurate fact clearly and simply. For example:“ When it comes to [ X medical problem ], [ Y medicine ] is the recommended choice for you.”
Name the misinformation( the filling): Briefly mention the existence of the myth without using its vivid language and name the consensus.“ There have been unsupported claims recently suggesting a link to issues. These claims lack rigorous evidence and have been rejected by the experts in the field.”
End with the truth( the second slice of bread): Reiterate the actionable truth.“ Remember, [ Y medicine ] remains the trusted option because the actual danger we must avoid is [ X medical problem ], which poses a real risk to you.”
Shift the Focus to Risk of Omission
Lastly, misinformation often exploits the“ better safe than sorry” mentality. For patients hesitant about a vaccine or medication, gently shifting the focus to the risk of doing nothing can be powerful. I think it is important to contrast the known risk versus the theoretical risk. Teaching the patients this way helps them make a better shared decision with their physician.
Final Word: Be the Trusted Messenger
Your authority is not rooted in your title alone, but in the personal trust you build. Patients listen to their own physicians more than to any celebrity or politician. I would bet that information has been weaponized since humans have had the ability to communicate with each other. Our most influential tool remains clear, compassionate communication that respects the patient’ s intelligence while guiding them back to the evidence. We must proactively address the misinformation we know is circulating, not just sit back and accept that patients will not listen to us.
We cannot force agreement, but let’ s avoid the“ Argument Clinic,” where the conversation disintegrates into a simplistic back and forth of contradictory statements. While we cannot expect ourselves to convince all patients, the goal is not to sell arguments by the minute but to help as many patients as we can understand that our aim is to build care plans that are in their best interest to follow, because they make sense for them, their family and their livelihood.
Dr. Higgins is a rhinologist in private practice at Kentuckiana ENT, a division of ENTCC, and President and Chairman of the Board of ENT Care Centers( ENTCC).
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